Senator Harkin

Senator Harkin

Senator Tom Harkin of Iowa recently wrote an op-ed piece to explain how Congress is going to design a new and improved health-care system that will take care of everybody while focusing on preventing diseases. 

I’ve copied some quotes from Harkin’s op-ed, which are in italics.  My comments on the quotes aren’t.

With the Senate health committee convening daily to craft a comprehensive health reform bill, the basic outline of this landmark legislation is now clear.  Yes, it will ensure access to affordable, quality care for every American.  But, just as important, it will hold down health care costs by creating a sharp new emphasis on disease prevention and public health.

When politicians talk about holding down costs, it’s time to hold onto your wallet.  When Medicare was enacted in 1965, it was projected to cost $12 billion in 1990.  The actual cost in 1990 was $107 billion.  The congressional budget-crunchers were only off by 792 percent.

We spend a staggering $2.3 trillion annually on health care – 16.5 percent of our GDP and far more than any other country spends on health care – yet the World Health Organization ranks U.S. health care only 37th among nations, on par with Serbia.

I’m not happy with our health-care system either, but the World Health Organization’s rankings are waaaaay skewed.  (Honestly, would you rather be taken to an emergency room in the U.S. or Costa Rica?)  I looked up how they calculate those rankings and will write about that – plus more about health-care costs, etc.  – on the TomNaughton.com blog, probably next week.

How can this be so?  The problem is that we have systematically neglected wellness and disease prevention.  Currently in the United States, 95 percent of every health care dollar is spent on treating illnesses and conditions after they occur.  But we spend peanuts on prevention.

I agree; we medicate symptoms instead of preventing diseases in the first place.  Hey, maybe this Harkin fellow is onto something …

Consider this: Right now, some 75 percent of health care costs are accounted for by heart disease, diabetes, prostate cancer, breast cancer, and obesity.  What these five diseases and conditions have in common is that they are largely preventable and even reversible by changes in nutrition, physical activity, and lifestyle.

Yes!  These are the “diseases of civilization” and they can certainly be prevented.  Go, Harkin, go, Harkin, go, Harkin, go!  Maybe I’ll move back to Iowa, where I spent much of my childhood, just so I can vote for Senator Prevention in the next election.

Listen to what Dr. Dean Ornish told our Senate health committee: “Studies have shown that changing lifestyle could prevent at least 90 percent of all heart disease.  Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle.”

AAAAAAAAAARGGGGHH!!!  Cancel that move back to Iowa.  Senator Prevention is quoting Dean Ornish, one of the biggest promoters of grain-based, lowfat diets.  This is the same diet recommendation that triggered the rise in obesity and the epidemic of diabetes we see today.

We also have to realize that wellness and prevention must be truly comprehensive.  It is not only about what goes on in a doctor’s office.  It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more.

Ah, yes, that’s why our grandparents were lean and had a fraction of the Type II diabetes rates we see today:  it was all those wellness programs, bike paths, walking trails, and federal school-lunch programs.  Boy, if we just hadn’t gotten rid of those programs, we’d be in fine shape today.

Winston Churchill famously said that “Americans always do the right thing – after they’ve tried everything else.”  Well, we’ve tried everything else, and it has led us to bad health and the brink of bankruptcy.

Yes, we have tried everything else … like federal nutrition guidelines pushing a lowfat diet, a federally-designed Food Pyramid, a school-lunch program that’s required by law to follow that pyramid, and a federal committee that declared dietary fat and cholesterol to be the cause of heart disease.

Okay, enough of the Harkin quotes.  You can read his full op-ed here.  The point is, nothing’s going to change.

Preventing heart disease, obesity and diabetes is a great idea.  But if you think solid advice on how to do it is going to come from the federal government, you must have been asleep for the past 30 years.  It was yet another Senate committee, plus the USDA and FDA, who told us to avoid fat, eat lots of whole grains, and go on low-fat diets.  The federal committee that was just assembled to re-write the federal nutrition guidelines is comprised of the usual suspects: so-called experts who think the key to health to simply eat less and cut back on fat. 

And let’s think a bit about Senator Harkin himself.  He’s a senior member of the Senate Health, Education, Labor and Pensions Committee.  That means he’ll be deeply involved in any new health and nutrition guidelines that are woven into the new health-care bill.  He’s also the senior senator from Iowa – you know, the state that grows all that corn we learned so much about in the documentary King Corn. 

Mountains of federally-subsidized corn are the reason you find high-fructose corn syrup in pretty much everything these days.  Cheap corn syrup is the reason 7-11 can sell you a 44-ounce Big Gulp that costs less than a bottle of carbonated water, and fast-food restaurants can hand you a cup the size of your head and let you have unlimited refills.  Dirt-cheap corn is also the reason ranchers don’t raise their cattle on grass anymore.

So … what do you suppose the odds are that Senator Harkin’s committee will conduct an exhaustive study of what’s causing obesity, diabetes and heart disease, then announce an end to all federal corn subsidies? 

What are the odds that the USDA – whose mission is to sell grains – will announce that putting breads and cereals at the base of the Food Pyramid was a dumb idea? 

What are the odds that the hundreds of scientists who work for the National Institutes of Health but have lucrative contracts with pharmaceutical companies will stand up and declare that cholesterol doesn’t actually cause heart disease and the anti-fat campaigns where misguided?

Yes, our health is declining and our health-care system is an expensive mess.  Kids are becoming insulin-resistant now, and nearly one-quarter of all senior citizens have Type II diabetes – and that figure doesn’t even count the millions of pre-diabetics who are nonetheless suffering the health consequences of producing too much insulin.

Thank God the federal government is going to do something about it.  They did such a bang-up job last time around.

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14 Responses to “Health Prevention”
  1. agnostic says:

    Might as well do some shameless self-promotion. The fat-phobes always say, “If only we ate more of X and less of Y, we’d be much healthier.” As far as I can tell, the low-carb people haven’t really assembled a series of clear-to-read charts of what we’ve been eating more and less of, except for the NHANES data that show the changes in fat, protein, and carbs. (Even then, it’s only for the past 30 or so years.)

    So I went to the USDA’s own Agricultural Statistics data, and what do you know? We’ve been cutting way down on red meat, white meat and fish are up, vegetables (yes, even the dark green leafy ones) and fruits are too, dairy and eggs are down, and grain had been plummeting from 1910 until 1970, and since then it’s up. Caloric sweeteners are also up, but have dropped in the past 10 – 15 years.

    http://lowcarbartandscience.blogspot.com/2009/06/did-following-experts-diet-advice-make.html

    There are also two graphs, one that everyone already knows — the increase of obesity and overweight. But the AHA just released a new version of their summary statistics, and there’s a graph showing the rise in heart disease incidence since 1970.

    So, we have in fact been following the experts advice. After looking at those graphs, they can’t blame it on our not doing what they told us. And yet, higher obesity / metabolic rates and heart disease rates!

    How long do you think it takes the government to read *its own statistics*. For crying out loud, they’re available as Excel spreadsheets on the internet. All you have to do is find which column you want to make a graph of and whip it up in 5 seconds in Excel.

    Shameless promotion of good information is not only allowed, but encouraged. Those are very illuminating charts. I may post some of them this weekend with a link back to your page.

  2. Nick says:

    Tom, you should check out this article: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
    Has nothing to do with the dietary recommendations, but it does go a bit into how systems like the Mayo Clinic spend a third as much money per patient, and have better outcomes, and why that is. If we could get sane dietary recommendations as well as rejiggering the medical communities to align the interests of every doctor with patient outcomes rather than racking up billables, those healthcare costs would come down dramatically.

    Good article, although I disagree with one of the author’s conclusions near the end: “When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician.”

    There is one area of medicine where costs have come down even as quality has improved: elective procedures. That’s because they’re not covered by insurance, so doctors advertise and compete on both quality and prices, and consumers shop around.

    Any time you hide the cost from the consumer, over-consumption is inevitable. The over-consumption then leads to higher prices, which leads to government-imposed price caps, which leads to producers taking themselves out of the market, which leads to shortages. (Then you have people dying after spending a year on a waiting list for a bypass.) It’s happened over and over, with everything from meat to gasoline to vaccines, but the regulators never seem to learn the lesson.

    Sane dietary recommendations would indeed go a long way towards reducing costs. So much of what ails people as they get older — diabetes, heart disease, cancer, Alzheimer’s — is caused by or accelerated by high blood sugar and excess insulin.

  3. Nick says:

    Oops…forgot to say great post! Looking forward to your next one.

  4. Madie says:

    Hi Tom,

    What do you think about a vegetarian ( not vegan) low carb diet?
    ( like this one: http://www.low-carb.org.uk/vegmealplan.htm)

    I’m vegetarian ( don’t like the idea of killing) and i want to go on a low carb diet because I think is healthier. ( I don’t want to lose weight , i’m thin )

    Waiting to see your movie!
    Madie

    Those are very sensible guidelines. I was impressed that the writer cautioned vegetarians about soy. I’d add gluten to the caution list.

    I think if you’re willing to get some animal fats and proteins in the form of eggs and possibly dairy (assuming you’re not allergic, which many people are) you can do just fine. In my vegetarian days, I made the mistake of loading up on grains and potatoes. You obviously know better than to repeat that mistake.

    Enjoy the movie.

  5. TonyNZ says:

    Madie, Dave Dixon has interesting info on wheat germ agglutinin (sp?) as well as far as things to avoid go.

    Also, if you have the choice, if ethical concerns are your driver and you are vegetarian as opposed to vegan, try to get pasture fed dairy products. Then they are raised in a field, not a shed. Theres biochemical concerns I won’t go into but pastoral dairy is better all around.

  6. Ellen says:

    Madie,

    May I suggest you read The Vegetarian Myth by Lierre Keith. She was a vegetarian for 20 years for moral, political and health reasons. So she deeply understand what drives people to be vegetarian and discusses all of these aspects. She is writing the book to make clear all the facts that she was never told. They are complex and interdependant.

    As far as not wanting to kill anything, the reality is that all life depends on death. It is a circle. There can be no life without the death of something. Even your pastured dairy products require death. the cow must give birth each year to keep producing milk. The males will become meat , someone will eat them. Maybe not you, but someone.

    Please read this book and then decide what makes the most sense. With the complete removal of most of us from the actual production of food, it is easy to think there are clear cut answers to these challenging questions. It a complex issue that deserves open minded inquiry.

  7. Michelle says:

    Tom, where is the beef lobby? The grain lobby has seemingly done so well, but not the cattle ranchers? I don’t know if this is a silly question or not!

    I’ve wondered that myself. I can only guess that the grain producers are much more numerous and much more powerful. And of course, the USDA wants to promote grains.

  8. Ellen says:

    I think, in these days of CAFO’s ,the grain lobby IS the beef lobby.

  9. I think most people reading this know elevated Insulin Levels influence levels of Inflammation so when we look at that list heart disease, diabetes, prostate cancer, breast cancer, and obesity not only are we looking at a list of conditions each of which is associated with high inflammatory status, we are also looking at a list of conditions associated with low anti-inflammatory status.
    Grassrootshealth have an excellent set of videos from Vitamin D experts that set out the science They also offer 25(OH)D testing at cost as part of a trial.
    We can debate and research for ever on whether it’s a chicken or egg first, scenario but acting now to correct vitamin D status to achieve the sort of level that allows human breast milk to flow naturally replete with vitamin d3 and is also associated with the lowest incidence of chronic illness may be, along with reducing the inflammatory content (grains and omega 6 vegetable oils)of our diets may be the quickest and cheapest solution to the increasing epidemic of chronic diseases.

    Good point. After doing some reading and listening to some vitamin-D researchers on Jimmy Moore’s show, I started supplementing with vitamin D.

  10. KD says:

    This is what I find so incredibly depressing– that right now, the government is trying to get more involved in healthcare and preventative care, except the government subsidizes that which is making us sick, and yet somehow they will make us well? It’s so frustrating that we could all save so much tax payer money by eating low carb, as everyone’s health would improve, eliminating a huge amount of “preventive care” that’s such a buzz word right now. Watching pundits argue about how we can pay for healthcare seems so needless when us enlightened few have the easy solutions about how to get healthcare down to manageable costs!

    And though I hate lobbies as a general rule, I have to wonder along with Michelle… it sounds like a beef lobby is what we need. If we have to have silly subsidizing at all, I’d rather be able to get some grass fed beef for cheaper as opposed to carbonated corn water.

    The current debate over health care costs is like arguing over who’s going to pay for all the smoke-jumpers and firefighters, even as the government continues tossing flares into the forest. We could slash our medical costs with two simple actions: announce that the food pyramid is nonsense and grains aren’t good human food, then end all grain subsidies.

  11. Paul B. says:

    I too read Harkin’s column with some amusement. Didn’t pick up on the irony of him being from Iowa, no doubt responsible to a great degree for the endless supply of cheap corn you refer to.

    I have serious doubts about the ability of “preventive care” to reduce health care costs. Studies have shown this is a myth, and Mike Eades had a great post on the topic a while ago. If by “prevention,” people mean exercise, smoking cessation, avoiding junk food, etc. this will probably cost society more in the long run because we all have to die of something, and the longer people live, the more resources they consume (esp. Social Security and Medicare). If “prevention” means testing everyone for every possible dreadful disease they might get, and then medicating the hell out of anyone who is “at risk” for any of these diseases, then medicating them more because of the side effects of the original meds, it doesn’t take a genius to see how this could get very expensive.

    Good point. The excuse to tax the bejesus out of smokers (I’m not one, by the way) is that they’re more likely to develop a disease and draw on Medicare. But they also die younger and stop collecting Social Security.

  12. Noumenon says:

    When Medicare was enacted in 1965, it was projected to cost $12 billion in 1990. The actual cost in 1990 was $107 billion. The congressional budget-crunchers were only off by 792 percent.

    If you know your history, you know that Medicare was increased by Congress just about every election till 1980. You can’t say the prognosticators were off for not predicting their program would be increased by future Congresses. That would be similar to saying the F-15 had a 100% cost overrun because they originally planned to buy 50 for $100 million and ended up buying 100 for $200 million.

    How would Congress have avoided increasing Medicare? By denying newly-developed drugs and medical procedures to senior citizens? By refusing to adjust rates paid to doctors to account for inflation? They always vastly underestimate the cost of these programs, and they’ll do it again. The prescription-drug program was budgeted at $400 billion; a year later the projection went to $1.2 trillion.

    Whatever the reason for the increases, they always happen. Anyone who trusts a congressional budget projection for a new entitlement program is dreaming.

  13. Noumenon says:

    I would be a lot more comfortable if you would post comments under your own name rather than going in and editing my posts. It makes it feel like we’re on a very unequal footing.

    There are plenty of programs that don’t get renewed and increased every year — just not the ones that benefit politically powerful old people.

    I don’t edit anyone’s posts, other than to add my comments. I do that because if I reply in a separate comment, it may be separated from the original by 10 other comments, which makes it difficult to people to connect the comments and replies.

    I’m not sure what, if anything, we’re supposedly disagreeing about. We certainly agree that politically powerful old people scare politicians into making stupid decisions. All large voting blocks scare politicians into making stupid decisions, and once millions of people are enrolled in government health care, they’ll only add to the problem. Decisions won’t be based on fiscal wisdom, they’ll be based on how those people will vote.

    Are you trying to suggest that this will be the one entitlement program that will stay within budget and be cancelled when it turns out to be more expensive than anticipated? Name one entitlement program that’s ever been cancelled. We’ve still got farm-support programs in place that were intended to help farmers through the Depression.

  14. mezzovoice says:

    Much as I disagree with Dr. Ornish’s dietary rules, there is one thing where he appears to have to right end of the stick: besides nutrition his focus is on meditation, calming down, destressing etc. etc. Now that ties in nicely with the findings of Dr Malcolm Kendrick in his book “The Cholesterol Con”. He thorougly dismantles the myth and finally comes to the conclusion that it is stress, that causes heart disease. So Dr Ornish’s success with heart disease may well be due to his dedication to stress-relief which obviously works so well that his patients do well IN SPITE of the stuff he feeds them. I don’t think that this will have occurred to him, though.

    It may have occurred to him, but if so, he’s not going to come out and say it, since he still pushes the low-fat diet.

    That’s been my beef with Ornish’s claims all along. He has his patients quit smoking, start exercising, undergo stress management … oh, and by the way, adopt a low-fat diet. Then when their rate of heart disease drops, he credits the diet. If I took a bunch of smoking, stressed-out couch potatoes and got them to meditate, relax, exercise, give up smoking and start chewing tobacco, their rate of heart disease would also drop — but that doesn’t mean chewing tobacco cures heart disease.

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