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Insurance premiums and medication prices are shaping the debate of the Democratic race for a good reason: 60% of US voters have at least one chronic disease and 40% have two or more.
While providing affordable care for people with sickness is critical, focusing on preventative healthcare will substantially reduce costs, improve quality of life, and stop the fast-growing epidemic of chronic conditions in the US.
To the blockbuster-question “How do you pay for it?”, all candidates argued about which pocket to tap into to pay for the highest healthcare bill of the western world. Instead, they should have geared the debate toward how to lower it. In fact, just like for climate change, the math and science are clear. Heart disease, diabetes, and cancer are responsible for 70% of healthcare expenditures and are largely preventable through lifestyle modifications.
The Center for Disease Control estimates that eliminating three risk factors – poor diet, inactivity, and smoking – would prevent: 80% of heart disease and stroke; 80% of type 2 diabetes; and, 40% of cancer. The problem with these numbers is that they thwart preventative healthcare from political debates by reinforcing a narrative that puts the burden on individual choices and consumer education. Nothing could be less true.
Any serious healthcare strategy should place agricultural policies and food system reforms as a pressing priority:
The heavy subsidies of monoculture in the Corn Belt is making grains, dairy, and animal products cheaper than fruits, vegetables, and nuts.
Food insecurity and food deserts are preventing millions of Americans from getting the nutrients they need from food.
The mismatch between what science recommends and the food pyramid guidelines is making Americans sicker and fatter. This is true in school cafeterias. This is true in supermarkets aisles. This is true in prisons.
The lack of food education in schools combined with unregulated direct-to-consumer ads for processed foods is making food stamps beneficiaries opt for ultra-processed foods because of their long shelf-life and popularity with kids.
Fifteen states are still allowing fast food chains to serve food inside hospitals.
The list can go on to include hundreds of other facts proving the trivial opportunity to rethink healthcare outside and inside hospitals’ walls.
Furthermore, beyond food and agriculture, the current healthcare system is antiquated. It has been built to fight infectious diseases and designed for acute care. As we have been living longer and successfully surviving infections, the burden of health costs is shifting to chronic disease. Any efforts to expand prevention to cater to the emerging pandemic of obesity and diabetes require systemic changes in how healthcare is taught, delivered, billed, and reimbursed. We need a 21st-century Flexner report.
Back in 1910, the Flexner report’s vision was to make medicine a scientific discipline. It ended up glorifying the reliance on lab research and acute interventions rather than anticipating the genesis of disease before the occurrence of symptoms or life-threatening events. The legacy of this report is behind many absurd decisions within the healthcare sector that prevent all initiatives aiming to maintain good health if they’re not relying on medicalized and surgical procedures or drug treatment facilitation. As a consequence, healthcare providers and payers are not promoting cognitive interventions with delayed long-term results. They prefer magic bullets that live up to patients' expectations of immediate pain relief without tackling root causes.
There is another way.
People should be part of the healthcare system before being qualified as “diseased”.
It starts with agricultural policies, school meals, hospital amenities, supermarket aisles, and food labeling.
It’s about doubling down on the SNAP program and gamifying its use to promote healthy habits.
It’s about urban zoning for fresh food service amenities and the revamp of the food pyramid to move away from animal protein and promote a plant-based diet.
It’s also about the role of primary care reimbursement parity for cognitive versus procedural care and payers contribution to non-patentable therapies like clinical-grade meals and health coaching beyond the 3 hours currently covered by Medicare for “sick-care”.
We need visionary policies and a bold strategy to win the fight against chronic disease. Just like smoking and climate change, the fight to improve public health is a global one.
Today, we have the opportunity to rewire the status-quo. There is a public health crisis - one that deserves a dedicated Town Hall debate to give the opportunity to candidates to articulate their measures to help reshape the definition of healthcare as we know it.
Let’s make this happen, please sign this petition petition to call for dignity in healthcare.
In health and gratitude,
Lamiaa Bounahmidi Founder WeTheTrillions Public Benefit Corporation