The Future of Healthcare in the USA

What is the nature of our healthcare system?
· The United States has a Multilevel Healthcare system
· The first level is the privately insured citizens
· Then is the insured by the government, e.g. Medicare, Medicaid and Federally insured employees and VA Healthcare system.
· The last tier is the 40 million citizens who are not insured. Of course, these are not really uninsured because law prohibits the refusal of medical care at any hospital. Ultimately the cost is born by the general population in any case.
What is the nature of the US healthcare system that may contain the seeds of its own failure?
· Allopathic medicine has as its goal that all diseases have a cure.
· Homeopathic medicine proclaims that treatments with opposite effects to the main disease will provide the curative effect.
· Osteopathic and Chiropractic medicine proclaim that all disease emanates from disorders or imbalances or malalignment of the spine or musculoskeletal system.
All of these medical philosophies have embedded the notion that disease or injury occurs as a natural life experience and that each ailment has a prescribed treatment.
· The primary problem with this view of disease and health is that it ignores the long tradition of Preventive Medicine which has demonstrated that a large number of diseases can be prevented or modified.
· Many of the most debilitating diseases and most expensive to treat can be prevented. For instance, chronic emphysema can be prevented by avoiding tobacco use. Similarly, avoiding tobacco can limit hypertension, coronary artery disease and stroke. It has been observed that a form of Raynaud's disease or phenomenon on, a cold induced constriction of the arteries of the extremities can be worsened if the patient is a smoker. This form of the disease is called Berger's Syndrome. The cure or the treatment is to STOP SMOKING!
· Where there is allergy, there is the opportunity to both prevent exposure to the allergen (latex allergy exposure) or to preventively treat seasonal allergy with non-sedating antihistamines.

· Thus the problem with the current system is that it is monetarily unsustainable. The most cutting edge technology for the treatment of heart disease, chronic pulmonary disease, and stroke is very expensive. If these treatments were available to everyone, the cost would be prohibitive. The least expensive and most healthful solution, therefore, is to incentivise the population to avoid unhealthful practices like smoking.

So how do we apply modern science to prevent these conditions?
· Vaccines to prevent many infectious diseases.
· Well rounded diets with enough calories to sustain good health.
· Exercise.
· Avoidance of tobacco and alcohol and illicit drugs.
· The preventive application of medicines for the treatment of Hyperlipidemia, hypertension, and coronary artery disease.
· Use vaccines, as they become available, for the prevention of cancer and immunodeficiency diseases, should be fully subsidized.

A Recognition of the interdependent state of employers and employees
· "In cheap years, it is pretended, workmen are generally more idle, and in dear ones more industrious than ordinary. A plentiful subsistence, therefore, it has been concluded, relaxes, and a scanty one quickens their industry. That a little more plenty than ordinary may render some workmen idle, cannot well be doubted; but that it should have this effect upon the greater part, or that men in general should work better when they are ill fed than when they are well fed, whey they are disheartened than when they are in good spirits, when they are frequently sick that when they are generally in good health, seems not very probable. Years of dearth, it is to be observed are generally among the common people years of sickness and mortality, which cannot fail to diminish the produce of their industry".
An Inquiry into the Nature and Causes of the Wealth of Nations. Adam Smith

The benefits of a fit and healthy workforce
· Adam Smith in 1776 noted that in general people work better when they are not ill. Employers get better work from their workforce when they are not ill. In other words, the healthier the workforce the greater the worker productivity.
· That nothing has changed in the 200 years of Adam Smith's observations is to recognize his prescience. Now we have the means to keep more people healthy than ever before.

It is more important for the employer to recognize the costs of an ill worker
· How much does it cost to make or keep an employee well? This is a model that implies that if you pour enough money into health care insurance, at the end of the day, you will have a healthy workforce.
· The real question that should be asked is how much does it cost the employer when his workers are ill? This allows the complete cost calculation of an ill worker. First there are the sick days pay, then there is the lost productivity, then there is the productivity index (PI= salary x value of the product produced). The least of the costs are the medical costs.)
· Placed in this context, there is a recognition that where the "health dollars" are placed may make a significant difference to the overall health of the company.
· If the empoyer makes an effort to place Preventive Dollars into the benefits package, he will have a healthier workforce. Instituting programs such as weight reduction, blood lipid control, hypertension monitoring, monitoring of chronic diseases in his workforce and making sure that employees have no untreated mental health issues all will have a salubrious effect on the work force.
· The Salubrious Effect: The return in productivity gains, decreased short term and long term disability costs, less staff turnover and a happier and healthier workforce. The literature indicates that the return on investment is at a minimum 3:1.

It is the mission of OMAS to bring the science of disease prevention to the workplace so that the benefits are calculable for the Employee and the Employer.

Member, American College Of Occupational Aand Environmental Medicine
Diplomate, American Board Of Family Practice