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Obamacare's 'original sin' is still the biggest problem with US health care

  • Trump's decision to terminate cost-sharing payments under Obamacare will destabilize health insurance markets.
  • But to fix our system, we have to address the root cause of America's health care problems: Unhealthy lifestyles that account for 50-70 percent of health care costs.
  • Until we address the lifestyle issues creating the need for expensive treatments, costs will continue their rise inexorably.

President Trump's latest actions on health care – his executive order creating "association health plans" and terminating cost-sharing payments under Obamacare – will further destabilize health insurance markets and create chaos for tens of millions of Americans who need health insurance.

The Trump administration's lack of a viable strategy for American health care just magnifies the original sin of the 2010 Affordable Care Act (ACA), which failed to address the root cause of America's health care problems: Unhealthy lifestyles that account for 50-70 percent of health care costs. Even if Senators Lamar Alexander and Patty Murray broker a short-term compromise to renew insurance subsidy payments, we are only putting Band-Aids on a broken system. Until we address the lifestyle issues creating the need for expensive treatments, costs will continue their rise inexorably.

Consider these sobering facts:

  • America ranks 42nd in life expectancy, among the lowest of all developed nations.
  • In 2015 the U.S. spent $9451 per capita on health care, highest of all developed nations.
  • Obesity among American adults has grown from 13 percent to 38 percent.
  • More than 70 percent of Americans are overweight.

A sound American health care program must contain four essential pillars:

  1. Improving individual health status
  2. Realizing efficiency and effectiveness of clinical care
  3. Shifting from fee-for-service to value-based health care
  4. Achieving equity in access to health care

Access to government-paid health care has improved significantly under the Affordable Care Act (ACA), but these gains are being undermined by removing individual and employer mandates, refusing to reimburse insurance companies as required under ACA, and eliminating information programs encouraging people to sign up for insurance. These actions will cause major increases in 2018 insurance premiums, putting comprehensive, affordable health insurance out of the reach of many Americans.

"As citizens, we have the responsibility to lead healthy lives, and share the fiscal consequences of our decisions when we don't. Until we do so, health care costs will continue to escalate, while our collective health declines further."

The current health care debate in Washington centers around who should pay. Democrats want universal coverage with the state paying for those who cannot afford it. Republicans prefer a private system while continuing Medicare with constraints. After Republican bills to "repeal and replace" ACA failed three times, the President shifted his focus to undermining it by executive orders. But the reality is that neither political party's actions will result in a sound, sustainable health care system focusing on improved health.

Instead of waiting until people are seriously ill with chronic, often incurable diseases, America should shift its efforts to keeping people healthy in the first place. As citizens, we have the responsibility to lead healthy lives, and share the fiscal consequences of our decisions when we don't. Until we do so, health care costs will continue to escalate, while our collective health declines further.

A recent study by the Harvard School of Public Health (HSPH) demonstrated 80 percent of coronary artery disease could be prevented by four basic lifestyle improvements:

  1. Don't smoke (or quit if you do)
  2. Maintain a healthy weight
  3. Be active and exercise
  4. Eat a healthy diet

Note that Harvard is not suggesting anything radical, or even increases in cardiovascular drugs, in-patient programs, or unproven forms of medical treatment. The HSPH study indicated these four improvements could reduce 50 percent of ischemic strokes, 80 percent of sudden cardiac deaths, and 72 percent of premature deaths related to heart disease.

Public opinion shifts and common-sense laws have dramatically reduced the number of Americans who smoke. Now, the same can be done to address obesity, inactivity, and excessive stress, which are the major causes of cancer, cardiovascular disease, Type 2 diabetes, joint and spinal surgery, and many other chronic diseases.

Efforts for healthy living are accelerating across the country, but are disproportionately concentrated among those who can afford them. People in lower social-economic categories are more likely to live in "food deserts," areas that lack access to healthy foods. They have more limited opportunities for exercise. In addition, they are often beleaguered by toxic stress and trauma – serious problems that are better handled outside institutional health care.

There are no easy or immediate solutions to such intractable problems. Achieving success will require sustained commitment across the country from government programs working in public-private partnerships with health care institutions, corporations, and non-profit organizations.

A comprehensive plan should include these elements:

  1. Develop a nationwide public awareness program to encourage healthy eating, exercise and stress reduction programs through electronic and print media and social media.
  2. Broaden reimbursement for complementary procedures such as acupuncture, therapeutic massage, physical therapy, and weight reduction programs that have been verified by research.
  3. Establish local community health centers concentrated in economically-disadvantaged areas, supported by local, state and federal resources, with an emphasis on group classes for healthy eating and nutrition, exercise, and healing from trauma and toxic stress.
  4. Introduce mindfulness programs for stress reduction in schools and communities.
  5. Address the growing opioid crisis with drug addiction programs offered locally.

The resolution of our nation's health care problems won't happen overnight. Steady progress can only be achieved by a sustained national effort, just as it was with smoking. If instrumented correctly, this type of comprehensive program will prevent expensive medical treatments, and population health cost will fall. Such proof points will provide a model for more expansive government programs.

Unless we have the will to address these root causes of America's health care problems, costs will continue to rise rapidly as health declines further, regardless of what politicians in Washington decide.

Commentary by Bill George, a senior fellow at Harvard Business School, former Chairman & CEO of Medtronic, and the author of "Discover Your True North." Follow him on Twitter @Bill_George.

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