“Broken & Unaccountable:” American Healthcare – What to do instead?
As a chiropractor using functional medicine I have seen first hand that appropriate care is not being delivered for the root cause of illness. Drugs and surgeries are prescribed in way that forestalls the inevitable continuation of underlying pathology.
Many health professionals, especially early in their careers, would tell you healthcare is a calling. I’m not sure that there is a better job in the world than taking care of a patient. There are many doctors that are trying to fix the problems, but are facing some very strong headwinds. We’ve inherited a system that makes it difficult to prioritize the patient without neglecting the business’s bottom line.
As a chiropractor using functional medicine I have seen first hand that appropriate care is not being delivered to treat the root cause of illness. Drugs and surgeries are prescribed in way that forestalls the resolution of underlying pathology. If you have high blood pressure does it make sense to artificially lower it, or treat the cause of elevated blood pressure.
We all deserve healthcare that is patient-endorsed and that gets results.
What is driving healthcare problems?
Consumers have waited for politicians to ride to the rescue
There is a cost crisis and total lack of price transparency
Preventative care is rarely covered
Delivery of care is not designed to treat the root cause
Medicine is overprescribed (in 1997 2.4 billion prescriptions were written. By 2016 that number doubled to 4.5 billion)
We’ve all been taught that if you are going to criticize something that you should supply an alternate solution. Numbers 1 and 2 open up Pandora’s box. Therefore I’ll share a few observations and opinions, but spend the majority of this article on numbers 3,4, and 5. I’ll provide a case study that should help the reader relate to how this applies to you.
The media and politicians have polarized public opinions on healthcare and will continue to perpetuate this two-sided affair. You’re either pro affordable care act (ACA) or anti-ACA. You support a one-payer system or you believe in free market and competition. In reality it’s much more involved and we have yet to establish a meritocratic approach that reins in the cost, optimizes the delivery of valuable care, and ensures all Americans access to care.
This is especially important when speaking broadly about chronic disease (diabetes, obesity, heart disease, hypertension, fatty liver disease, etc) because it’s responsible for approximately 80 % of healthcare expenditures in the US ($3.5 trillion in 2017)
Did the affordable care act accomplish some things? Not denying people insurance with pre-existing conditions and keeping kids on their parent’s plans until 26 is embraced by the large majority. Did the ACA lower the price of health insurance in the United States by $2,500 per year? No! Will getting rid of it fix healthcare? I would argue that it would not, because in order for healthcare to be fixed we need a total re-haul. Does conventional medicine excel at preventing or reversing chronic disease?
The US healthcare system runs on a fee-for-service model where doctors get paid for the pills and surgeries they prescribe. This rewards quantity over quality. Doctors don’t get reimbursed for spending time with patients counseling them on the benefits of healthy eating and other lifestyle modifications. Until that reimbursement model changes medical care and education will continue on unchanged.
We need to be aware of what’s happening in the medical system.
A national study found that 21% of medical care was deemed unnecessary by physicians
A new study out of John Hopkins details how 48% of all Federal spending goes to healthcare
1 in 5 Americans have medical debt in collections
There is zero transparency when it comes to healthcare costs. Predatory billing and price gouging are hard to detect, but are commonplace.
The current system plays a game of inflating prices for insurance companies and making exorbitant amounts of money on the backs of patients. The days of plans with great benefits are gone.
Outside of your monthly premium it’s nearly impossible to know how much you will pay out of pocket, what the hospital or doctor will bill the insurance, and the degree to which what you paid for was medically appropriate.
People are getting crushed by their premiums and our health continues to deteriorate. If you’re interested in learning more about cost crisis and how to navigate within conventional medicine see the link Dr. Marty Makary new book, The Price We Pay.
Most doctors want to provide meaningful care to their patients.
What this means to me is keeping patients out of disease and empowering them to take health into their own hands.
If we look at the statistics around chronic disease it demonstrates that the current approach to healthcare is failing. Until patients have the right platform we will continue to go in the wrong direction.
Why don’t expensive insurance plans pay for the tests and therapy we need to prevent and fix disease at its core?
In the 1960’s the AMA [American Medical Association] agreed to drop its opposition to Medicare and Medicaid. They demanded that the new laws would back usual, customary and reasonable fees.
This was the beginning of ‘corporatized” care that lead to disproportionate fees for hospital visits, surgery, and technologic procedures for treating acute illness. Where reimbursement waned -- office visits for maintenance, treatment of chronic illnesses and/or for prevention. It’s important to note that during the time these fee structures were developed much of what we know about preventative evidence-based care has changed dramatically.
When creating a treatment plan or in doctor speak an “interventional therapy”, you should aim for a plan with a “curative effect.” Sounds simple but conventional medicine is not designed to provide us a cure. It’s meant as a way to manage disease.
Here is a very simple example. Patient goes to primary care doctor. Blood tests are run and results show high LDL cholesterol and triglycerides. Doctor then prescribes a statin drug to decrease cholesterol production and runs a basic lipid panel every year for 20-30 years while re-filling the prescription.
You should know that statins have not been shown to extend the lifespan in men under the age of 80 without heart disease, in women of any age, and in men over the age of 80 with heart disease. Moreover, statin side effects are often underreported!
If you have read any of my articles on heart disease you know that what’s important are the LDL particle numbers (lipoproteins) as well as markers for diabetes and inflammation.
How should you approach medical care?
Start with P4 medicine.
Personalized
Predictive
Preventative
Participatory
Healthcare practitioners want to spend our time on things that matter. So what matters to the patient?
Getting answers
Piece of mind
Understanding the treatment
The total perceived value of the care
Personalized care
Getting them back to what’s important in their life
Being included in the decision making process
Integrated care based on patient priorities
At this point in time if you are looking to stay healthy, reverse chronic disease, or even obtain a diagnosis you will have to do some work. This might mean working with an integrated team. For example I assist patients that are working with an endocrinologist, an obstetrician, personal trainer, and a psychiatrist. It’s key to find providers that can spend enough time with you. You will have to pay more up-front, but you will save beyond your wildest imagination long term.
Case Study: Functional medicine approach
Let’s talk about Karen. She is a 41-year-old, 5’4” woman who weighs 165 pounds and is premenopausal. Her goal weight is 135 lbs which was her weight before becoming pregnant with her second child.
She goes to the gym 3 times per week and performs some type of cardio i.e. elliptical or gentle yoga. She drinks red wine a few nights a week and has a self-confessed sweet tooth. She was recently diagnosed as pre-diabetic. Five years ago she was diagnosed with thyroiditis, but was told last year that her thyroid is “okay.”
She doesn’t sleep well and stays up late watching tv sometimes. She suffers from bloating and stomach upset. Conventional doctors have been unable to diagnose her with any gastrointestinal issues. She has tried Weight Watchers and paleo, but regains whatever weight she loses. Based on her 24-hour food diary her total calorie intake is about 2,400.
What are some of the things we did?
Recommend a “simple” Paleo diet template that provides around 1,900 calories per day, 25 percent protein (about 110 g), 25 percent carbs (about 110 g), and 50 percent fat (100 g). What the heck does that look like?
10 to 12 ounces of meat/chicken/fish/eggs
1.5 to two cups of starchy plants
one serving fruit
six tablespoons of added fats
We gave the patient the option of intermittent fasting with an eight-to-10-hour feeding window and suggested that she consume the recommended amount of food within that window.
We recommended that the patient get the following testing: SIBO breath test, Cyrex testing (as finances allow), and stool testing if needed. In her case we performed the stool test as her TSH levels were elevated as were her Anti-TPOs and it’s important to see if microbial imbalances may be promoting autoimmunity.
We ran a cardiometabolic panel and a full thyroid panel.
After 3 months of treatment (targeted supplementation, dietary and lifestyle modifications) Karen was able to loose 20 lbs. Her SIBO retest came back negative, and her blood sugar improved (HgA1C, fasting blood glucose and insulin). She has had 1 or 2 episodes of bloating, but her stomach pain has resolved.
What these results mean
Karen feels like she has control over her diet and weight
She won’t need to be on insulin or metformin in the future
She’s decreased her cardiovascular risk profile
She won’t need to take thyroid medication (at least not in the near future)
She has improved energy and anxiety has decreased since her stomach pain resolved.
This was a bit longer than I intended so I’ll wrap it up.
The best part about taking a comprehensive approach is the opportunity to “upgrade” a patient’s overall paradigm of health to one of prevention and empowerment as opposed to passive and reactive therapies.