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Surgeon General’s Warning: Obesity Is A National Security Issue

Photo of Steve Simmons, M.D.

Dr. Richard Carmona

I’ve interviewed Dr. Richard Carmona (the 17th Surgeon General of the United States, and former EMT, nurse, and surgeon) several times on this blog and have been intrigued by his insights and approaches to health. In our most recent interview, he discussed obesity from a provocative new angle: national security.

Dr. Val: What do you mean that obesity is a national security issue?

Dr. Carmona: There are many competing interests on Capitol Hill – the war, the economy, etc. and obesity is something that just doesn’t get enough traction. When I was serving as Surgeon General, I realized that obesity was acting as an accelerator of chronic disease and was the number one health threat to our country. But after several failed attempts to get attention focused on this issue, I realized that I had to present the message in a unique way in order to get it to resonate.  It occurred to me that if I used different language to describe the threat, people would allow me to connect the dots and explain the problem fully.

Retaining EMS, police, firemen, soldiers, sailors, and airmen has been challenging because many of them  can’t pass their physical fitness tests due to obesity and sedentary lifestyles. Health is therefore inextricably tied to national security. Describing the health threat in these terms helped legislators to understand the complex ramifications of the condition.

Dr. Val: How rigorous are these fitness tests? Are we talking about soldiers not being able to run a 5-minute mile, or is it less challenging than that?

Dr. Carmona: The fitness tests are based on research from the Cooper Clinic in Texas and include a measure of aerobic capacity, strength, and flexibility.  There are standardized minimums based on gender and decade of age, and although I don’t have the exact minimums memorized for each age group, they’re very reasonable. We’re not talking about having to run a 5 minute mile. More like having to run a mile and a half in 15 minutes or having the flexibility to touch your toes in a seated position. As far as push-ups are concerned, the qualifying range is about 20-45.

Dr. Val: One of my blogger friends relayed a story recently about a surgeon who asked his hospital cafeteria to serve healthy options instead of fried food. They responded that no one would buy the healthy food and they’d go out of business – so economic necessity required that they continue to serve unhealthy food. What would you say to that surgeon?

Dr. Carmona: I’d invite that surgeon to come out to Canyon Ranch where we serve healthy gourmet meals every single day.  Our chefs are very innovative and entrepreneurial – they make healthy food taste delicious, and at a cost-effective price.  Americans need to learn how to make healthy food delicious. My friend Toby Cosgrove is a surgeon at the Cleveland Clinic, and he was able to spearhead a healthy food initiative there that has been very successful.  We strive to find new and creative ways to prepare healthy food at Canyon Ranch – and are always coming out with new recipes and cookbooks to keep people interested in healthy eating.

***

I caught up with Dr. Carmona at the STOP Obesity Alliance briefing about the new GPS  (Guide for Policy and Program Solutions) initiative. Please click here to learn more about the STOP Obesity Alliance.

Grace-Marie Turner: Should Congress Expand Health Insurance To Cover All Children? No

Some thoughts to chew on from Grace-Marie Turner:

But expanding SCHIP to cover all children would be a mistake, for four reasons:

1. First, Congress should make sure poorer, uninsured children are covered first. At least two-thirds of uninsured children already are eligible for SCHIP or Medicaid but aren’t enrolled. If SCHIP were expanded to cover children in higher-income families, their parents would rush to the head of the line to get the taxpayer-subsidized coverage. When a “free” government plan is offered, it’s nearly impossible to resist. Poorer children would be left behind as states focus on enrolling higher-income kids.

2. Second, expanding the program would “crowd out” the private insurance many higher-income kids already have. Hawaii offers proof. Earlier this year, the state created a new taxpayer-financed program to fill the gap between private and public insurance in an effort to provide universal coverage for children. But state officials found families were dropping private coverage to enroll their children in the government plan. When Gov. Linda Lingle saw the data, she pulled the plug on funding. With Hawaii facing budget shortfalls, she said it was unwise to spend public money to replace private coverage children already had.

3. Third, putting many millions of children on a government program will quickly lead to restrictions on access to care. A young boy died in Baltimore not long ago from an untreated tooth infection, even though he was enrolled in SCHIP. Few dentists can afford to take SCHIP patients because the program’s reimbursement rates are so low. The boy’s mother couldn’t find a dentist to see him. In Massachusetts’ move toward universal health coverage, more people have insurance, but they are finding that physicians’ practices are often filled, with waiting lists for a new patient appointment at 100 days and counting. Putting more children on SCHIP will add to the program’s financial pressures, making it harder for poorer kids to get care.

 

4. Finally, government insurance means that politicians and bureaucrats, not parents, make decisions about the care children receive and about what services will or will not be covered.




Tom Daschle Will Be Next Secretary of HHS: What Does This Mean For Healthcare?

Tom Daschle - Photo Credit: CBS News

I’ve had my eye on Tom Daschle for many months – and attended a healthcare conference in June ’08 in which he was the keynote. I blogged about his ideas previously, but thought it would be valuable to repost them here (h/t to The Healthcare Blog):

Tom Daschle, former Senate Majority Leader from South Dakota, was the keynote speaker at the Fighting Chronic Disease: The Missing Link in Health Reform conference here in Washington, DC. His analysis of the healthcare crisis is this:

US Healthcare has three major problems: 1) Cost containment. We spend $8000/capita – 40% more than the next most expensive country in the world (Switzerland). Last year businesses spent more on healthcare than they made in profits. General motors spends more on healthcare than they do on steel.

2) Quality control. The US system cannot  integrate and create the kind of efficiencies necessary. The WHO has listed us as 35 in overall health outcomes. Some people ask, “If we have a quality problem, why do kings and queens come to the US for their healthcare?” They come to the best places like the Mayo Clinic, the Cleveland Clinic, or Johns Hopkins. They don’t go to rural South Dakota. We have islands of excellence in a sea of mediocrity.

3) Access. People are unable to get insurance if they have a pre-existing condition. 47 million people don’t have health insurance. We have a primary care shortage, and hospitals turning away patients because they’re full.

His solutions are these:

  1. Universal coverage. If we don’t have universal coverage we can’t possibly deal with the universal problems that we have in our country.
  2. Cost shifting is not cost savings. By excluding people from the system we’re driving costs up for taxpayers – about $1500/person/year.
  3. We must recognize the importance of continuity of care and the need for a medical home. Chronic care management can only occur if we coordinate the care from the beginning, and not delegating the responsibility of care to the Medicare system when the patient reaches the age of 65.
  4. We must focus on wellness and prevention. Every dollar spent on water fluoridation saves 38 dollars in dental costs. Providing mammograms every two years to all women ages 50-69 costs only $9000 for every life year saved.
  5. Lack of transparency is a devastating aspect of our healthcare system. We can’t fix a system that we don’t understand.
  6. Best practices – we need to adopt them.
  7. We need electronic medical records. We’re in 21st century operating rooms with 19th century administrative rooms. We use too much paper – we should be digital.
  8. We have to pool resources to bring down costs.
  9. We need to enforce the Stark laws and make sure that proprietary medicine is kept in check.
  10. We rely too much on doctors and not enough on nurse practitioners, pharmacists, and physician assistants. They could be used to address the primary care shortage that we have today.
  11. We have to change our infrastructure. Congress isn’t capable of dealing with the complexity of the decision-making in healthcare. We need a decision-making authority, a federal health board, that has the political autonomy and expertise and statutory ability to make the tough decisions on healthcare on a regular basis. Having this infrastructure in place would allow us the opportunity to integrate public and private mechanisms within our healthcare system in a far more efficient way.

What do I think of this? First of all, I agree with much of what Tom said (especially points 2-7) and I respect his opinions. However, I was also very interested in Nancy Johnson’s retort (she is a recently retired republican congresswoman from Connecticut).

Nancy essentially said that any attempt at universal coverage will fail if we don’t address the infrastructure problem first. So while she agrees in principle with Tom Daschle’s aspirations and ideals, she believes that if we don’t have a streamlined IT infrastructure for our healthcare system in place FIRST, there’s not much benefit in having universal coverage.

As I’ve always said, “equal access to nothing is nothing.”

I also think of it this way: imagine you own a theme park like Disney World and you have thousands of people clamoring at the gates to enter the park. One option is to remove the gates (e.g. universal coverage) to solve consumer demand. Another option is to design the park for maximal crowd flow, to figure out how to stagger entry to various rides, and to provide multiple options for people while they’re waiting – and then invite people to enter in an orderly fashion.

Obviously, this is not a perfect analogy – but my opinion is that until we streamline healthcare (primarily through IT solutions), we’ll continue to be victims of painful inefficiencies that waste everyone’s time.  It’s as if our theme park has no gates, no maps, no redirection of crowd flow, no velvet-roped queues, and the people who get on the rides first are not the ones who’ve been waiting the longest, but the “VIPs” with good insurance or cash in the bank. It’s chaotic and unfair.

Quite frankly, I think we could learn a lot from Disney World – and I hope and pray that next year’s healthcare solution is not simply ”remove the gates.”

What do you think?


Joan Lunden Loves Personal Health Records

Photo of Joan Lunden

Joan Lunden

Former Good Morning America host, Joan Lunden, is getting behind the personal health record industry. As the daughter of a physician, Joan grew up believing that she’d become a doctor one day. She told me that all that came to a screeching halt when she “realized that she didn’t like blood or stitches.” But Joan has always kept women and children’s health advocacy initiatives close to her heart.  She will soon be starring in a new Lifetime TV show called Health Corner. I caught up with her about her recent work with PassportMD.


Listen to the podcast here, or read a summary of our discussion below.

Dr. Val: Tell me about your experiences in taking care of your mom, and what led you to become involved with a PHR company.

Lunden: I lost my brother to type 2 diabetes a little over a year ago. As it happens, he had been managing my mom’s medical care, and so with his loss I needed to step in and take it over. Of course she lives on one coast and I live on the other. I’ve got 4 little kids (two sets of twins) and three young adult children. It becomes really daunting to keep track of everyone’s medical care. Around that time I met some folks from PassportMD, and when they showed me how easy it could be to keep everyone’s records in one place, I said, “this is exactly what I need.”

I think I’m really typical of a lot of women out there in what we call “the sandwich generation.” Today a high percentage of women with small children are working outside of the home. It’s really a lot to juggle – a career, raising a family, and getting everyone to the doctor on time – forget about getting YOU to the doctor on time. As good as we women are at nurturing others, we tend to be at the bottom of our own to-do lists.

What I really love about PassportMD is not just the organization (I can immediately see all my kids’ vaccination schedules for example) but the fact that I’m building a family medical history. It’s so important to know your family history so that you can engage in appropriate screening tests and take preventive health measures. This PHR even sends you reminders when its time for immunizations, mammograms, or other appropriate screening tests.

Dr. Val: As a doctor I’ve encountered resistance to PHRs from patients because they don’t want to have to enter all the data themselves. They’d like it to be auto-populated with their medical record data so that they don’t have to start from scratch. Has the PassportMD tool solved that problem?

Read more »

What Do Doctors Think Of McCain Vs. Obama Health Plans?

Photo of Obama and McCain ABC

A company called Epocrates – which produces drug, disease, and diagnostic guides for physicians – recently surveyed about 1100 physicians about their health policy and political views. These are the 6 questions they asked, with the results listed in descending order of popularity. I think you’ll find it quite interesting:

 

1. Who has a better plan for healthcare reform, Senator McCain or Senator Obama?

Obama: 47%

McCain: 30%

Neither: 23%

2. As a medical professional, are concerns about McCain’s age justified?

Yes: 51%

No: 49%

3. What issue or reform would you most like to see the new president tackle?

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