What If Doctors Were Paid to Keep People Well?
Legendary writer Eduardo Galeano had this to say on the subject of manufacturing disease:
Healthy? Unhealthy? It all depends on your point of view. From the point of view of the pharmaceutical industry, bad health can be very good. Take shyness, for example. This character trait used to be acceptable, even attractive. That is, until it became an illness. In the year 1980 the American Psychiatric Association decided that shyness was a psychological ailment and included it in its Manual of Mental Disorders, which is periodically updated by the high priests of Science. Like all illnesses, shyness requires medication. Ever since the news broke, Big Pharma has made a fortune selling hope to patients plagued by this “social phobia,” “allergy to people,” “severe medical problem…”
Today, Big Pharma revenues worldwide exceed $1.25 trillion, and the US spends over $3.6 trillion each year on healthcare. Keeping people “healthy”, or unhealthy, is indeed big business.
What if things were different? What if our healthcare system prioritized healing and wellness, and only treated patients when they were sick? It has been done before. Ancient Chinese doctors were paid a retainer to keep their patients healthy. If a patient did get sick, the doctor would not be paid for that person until he or she got well. Doctors who performed surgeries in this type of system were considered inferior because they were unable to keep their patients healthy. What if, like in ancient China, our healthcare system placed people over profits, and doctors were paid to keep people well, rather than just manage their diseases?
Close to 80% of all chronic diseases are caused by diet and lifestyle factors. If the US were to adopt an ancient Chinese like system where people’s wellness was the priority, a doctor educated on the powers of nutrition would most certainly prescribe a healthy plant-based diet to her patients. Why? For starters, a whole food, plant-based (WFPB) diet is the only diet proven to reverse heart disease, early stage prostate cancer and type 2 diabetes. In addition, according to a study by Harvard University, a healthy plant-based diet, along with a few other simple lifestyle changes, can extend a person’s life by 12–14 years. Well, you can do the math.
Dr. T. Colin Campbell has estimated that if everyone in the US adopted a WFPB diet, healthcare costs could be slashed by 70–80%. Conservatively, this would result in a savings of over $2.5 trillion per year (as well as the prevention of hundreds of thousands of premature deaths).
Even just reducing the need for hospital visits would save lives. Many years ago, The Journal of the American Medical Association (JAMA) estimated that 215,000 deaths per year in the US are due to medical care/errors (Johns Hopkins University reports that the number exceeds 250,000).
- 2,000 deaths/year from unnecessary surgery
- 7,000 deaths/year from medication errors in hospitals
- 20,000 deaths/year from other errors in hospitals
- 80,000 deaths/year from infections in hospitals
- 106,000 deaths/year from non‐error, adverse effects of medications
Part of the problem is that doctors are being taught by the very same system that is profiting from disease and producing so many medical errors. According to a recent study, the leading source of information for doctors on how to treat patients is drug representatives, and the most common reason that doctors give is that it saves them from having to do their own research. Over 50% of doctors list Wikipedia as their first choice for finding information on how to treat their patients, and many doctors also list YouTube videos posted on drug company websites as favorite sources for information. Yikes!
Dr. T. Colin Campbell has estimated that if everyone in the US adopted a WFPB diet, healthcare costs could be slashed by 70–80%.
Despite close to 65% of Americans agreeing that the government has the responsibility to provide health care coverage for all (a number that is likely higher today due to the pandemic), President Joe Biden has said that he will veto any “Medicare for All” legislation (even though 40–90 million Americans are either uninsured or underinsured, and a Yale University study found that “Medicare for All” would save $450 billion, and prevent 70,000 deaths per year).
All hope is not lost, however. Dr. Michael Greger once speculated that the primary reason diseases tend to run in families may be that diets tend to run in families. Adopting a healthy plant-based diet may not be easy, but the difficulty is not because plant-based eating is especially difficult, unpleasant, or expensive, but rather because of our respective cultures. Changing how we view food is not impossible, and once that change gains momentum, entire families and communities will follow. Center for Nutrition Studies (CNS) microgrant recipient Varun Ponmudi started his organization “Aaya’s Table” to bring culinary assistance to hospitals through healthy, whole plant-based home cooking. Aaya’s Table leaves the added oils, sugars, and animal products behind, and provides health promoting meal plans to people of all backgrounds through culinary traditions and familiar flavors. Varun hopes that Aaya’s Table will one day be the culinary arm that physicians embracing lifestyle change can rely upon and trust. Patients participating in the Culinary Rehabilitation (CuReTM) Program are already reporting strong results.
Although the Affordable Care Act (ACA) has been called a compromise on a compromise, it is also a step in the right direction. I was surprised to learn that there are provisions in the ACA that attempt to change some of the ways in which doctors get paid. The first are Accountable Care Organizations (ACOs), who work together to achieve agreed upon targets, and to save on expenditures. Providers have an option to earn an extra bonus by year’s end if they are able to keep their spending below expected financial outcomes. How so? Quality indicators are used to measure the quality of the healthcare service by monitoring how well doctors are able to control or improve disease markers, or by how often they are able to keep their patients out of the hospital. As a result, a financial incentive does exist for participating providers to reduce their costs by prioritizing the wellness of their patients.
A second alternative payment model may be introduced as well where doctors are paid a monthly “management fee” of roughly $20 per patient. Some patients will exceed the $20 per month cost, while others will not. Either way, doctors will have less interest in scheduling unnecessary follow up visits, and more interest in recommending healthy lifestyle changes.
There is a lot more to the story of medical treatment being the third leading cause of death in the US after cancer and heart disease. And most medical schools still don’t offer required courses in nutrition. We could also speak ad nauseum about the many reasons why the US spends the most on healthcare globally, yet still ranks last among industrialized countries in most quality of care measures. But what if we decided to no longer wait on empty promises from our elected officials? What if we demanded a different direction and created a seismic shift in perspective from our healthcare system, and how it operates? What if most people didn’t need to go to the hospital simply because they addressed diet and lifestyle factors, and had a doctor in their corner who was paid to keep them well? What if indeed!
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