Modern U.S. Healthcare, Where are we going?

We spend a great majority of our lives contributing to the society, and we expect our healthcare system to provide for our healthcare needs. Yet, it is a system that primarily focuses on disease management rather than health promotion. Unfortunately, even the very function of disease management may not have been satisfactorily performed by our current system. Does it sound all too familiar to some of us who has experienced the so-called health insurance “run-around”? Under the pretense of an attempt to control healthcare costs, certain tests are only partially covered or are not approved at all, and prior authorization is often required for this test or that medication, and yet insurance premium shows no sign of decline. Is such an insurance-driven disease-based healthcare system the only way for modern healthcare delivery?

The American ideal is founded upon liberty, and freedom cannot truly exist without choices. However, this is precisely the problem we now face with our healthcare system, its lack of options. For some strange reason, the cost of healthcare has been inflated so high that only the wealthiest can afford unless there is health insurance. But then it becomes obvious that every individual who subsequently seeks healthcare has to go through the same loop, the insurance hurdle, and comes with it the various types of restrictions! In an ideally free society, there must be choices, and healthcare is of no exception. By offering more options, we are not encouraging healthcare disparity but rather promoting diversity. In an era when healthcare consumers are increasingly responsible for their own healthcare expenditure with higher co-pays and deductibles, more choices should be offered to consumers and especially to those who may be interested in services not traditionally covered by insurance plans. The idea that someone else will pay for all our healthcare needs has long gone. Since we progressively have to pay more and more, would we rather pay for services that focus more on health promotion than just disease management?

Our healthcare system may seem to be part of a giant network of conspiracy. With the growth of both the fast food and processed food industries, we are rapidly becoming an unprecedented obese society. With the increasing level of stress from our work responsibilities, family duties, interpersonal relationships, and financial obligations, we progressively become more engaged in emotional eating and less in therapeutic exercise. Such a society thus imposes upon our population a greater risk of developing stress and obesity-related diseases. Due to the increasingly dwindling insurance reimbursement, most healthcare providers can no longer afford adequate time for lifestyle counseling but need to resort to a high volume practice in order to make their ends meet, and thus they simply have to rely more on medications to treat their patients, who perpetually may become more dependent on drugs, without which their conditions inevitably will recur and worsen, let alone the side effects of which that may demand even more medications to be taken in order to counter the initial adverse reactions, and interestingly this may appear to be exactly what the pharmaceutical industries desire.

Thus, what could be the solution? First, we need to understand the concept of health and disease. Absence of illness does not automatically mean achievement of health! Not being poor does not mean being wealthy; and not failing an exam does not mean obtaining an “A”. Health span is a spectrum, a continuum, like a rainbow, and cannot be categorized simply as all or none, sick or not sick. Disease is at one end of the spectrum whereas health occupies the other. Health insurance should really be interpreted as disease insurance. Despite the fact that modern medical technologies may prolong life span, they do not necessarily improve health span. Being alive does not equate to being lively! Quantity does not always lead to quality. Disease management is not the same as health promotion!

Second, we need to appreciate the importance of health promotion through prevention. Despite having the highest healthcare expenditure in the world, we do not rank the healthiest when compared with other industrialized nations. In fact, we are now witnessing an increased incidence of chronic diseases with an earlier onset. This implies that our population is becoming sick at a younger age, and since we can now live longer due to advanced medical technology, we will utilize the healthcare system longer, and thus creating more burdens to the already stressed system. Most healthcare experts would agree that prevention is potentially the most cost-effective and beneficial route to improve health. Numerous studies indicate an annual savings of $100 billion as well as increased longevity and quality of life if healthcare providers promote prevention. Thus, we should not go to our healthcare providers only when we are sick. The same concept can be applied to our cars. We would not prefer to go to our car mechanics only when our vehicles break down. Hopefully, we would oil change and tune up our vehicles even though our car insurance does not necessarily pay for those services. We would still wear sit belts and drive prudently despite the fact that we have car insurance. When our cars do break down, we could easily change parts or even get new ones. However, this is not so easily achievable for our bodies, and after all, we believe we are worth more than our vehicles. Therefore, let our healthcare providers help us to stay healthy and vibrant through prevention. The healthier we are, the less we have to worry about being sick and feeling miserable, and the less we have to concern about arguing with health insurance companies for coverage. Perhaps the time has come for an alternate model of healthcare delivery in the 21st century, one that changes from the fast-paced, drive-through, assembly-line, impersonalized, and reactive conventional medicine to the time-devoted, quality-driven, patient-oriented, individualized, and proactive integrative holistic medicine that focuses on prevention and wellness; addresses the whole person, body, mind and spirit; incorporates complementary and alternative medical therapies; and promotes optimal health far beyond the mere absence of  disease!

To fight and conquer all illnesses is not supreme excellence; to break the disease’s resistance without fighting is supreme excellence. Prevention is the key.

                                                                                                Dr. Kevin Chan