Sunday, November 3, 2013

Halloween & Healthcare ~ a call to action

Halloween - I typically dread Halloween - for weeks. I agonize over participating in the annual candy-fest. I view it as a day that contributes to addicting, yet another generation, to sugar - a major gateway drug to our most challenging, societal health problems. Consequently, I am loathe to participate in this pagan tradition turned Sugarween. 
I make no secret of my loathing. I have been known to turn off my porch light, darken my front windows with sheets and boycott the entire evening. My neighbors with children are gracious. “If we see your porch light out, we’ll know you just couldn’t do it.” 
AND I have been known to distribute boxes of raisins. Such was my Halloween this year. Armed with 168 mini-boxes of raisins - I was locked, loaded, armed and ready for the ghosts, ghouls, goblins, critters, fairies, bees, NASA astronauts, blue men, ballerinas, zombies and “humans” that rang my doorbell.
“Trick or Treat!” they screamed when I opened the door, thrusting orange, plastic, pumpkin buckets at me. Crowded from behind, sometimes the youngest, smallest ones  mounted the threshold.
“Ooh, you’re scary!” I’d say, or, “Who are you?” 
“Where’s your costume?” I asked my darling neighbor who wore long pants and a sweatshirt.
“I’m a human tonight,” she grinned, making me laugh. It was a good costume; human visitors were scarce on Halloween.
Her brother Daniel arrived with friends - all carrying pillowcases. They were obviously out for the long haul and big caché. He wore a purple “blue-man suit” and has for several years. Hooded behind a mask of purple fabric, his tall, skinny silhouette is unmistakable.
“You’re gonna outgrow that costume soon Daniel,” I said. Methinks he’s grown a foot in as many months and I’m sure he towers over all at home - a fact his father vehemently denies.
“No I’m not,” Daniel asserted confidently, “It stretches!”

Two young parents trick-or-treated with their infant. Huh?? I was puzzled. Were they checking out the neighborhood or desperate for candy?
A Mom, looking every bit the real ballerina with white and flowing tutu ala Swan Lake or The Nutcracker, came with her daughters. 
Two tweens knocked. Their princess costumes had bodices with spaghetti straps and skirts of tulle.
“Aren’t you freezing?” I asked.
“YES!” they chorused in unison before convulsing in gales of giggling. “Happy Halloween!” they chorused again as they ran down the sidewalk.
A little boy held the box high as he turned to run. “Mom, I got raisins!” he shouted with excitement. 

One girl, she could not have been more than eight, fished out the box of raisins to peer at it. “Oh I get it!” she exclaimed, “You want kids to be healthy!”
“You got it,” I grinned, “Less candy and more good stuff.”
“I’ll be sure to eat these,” she said sincerely. Smart kid, one after my own heart.

Can I write about Halloween, kids and candy without a segue to health? Hardly. What is the health state of the nation? Just shy of dismal. If we have one national affliction, its the disease of denial - a convenient one indeed.

Weight of the Nation - is a four-part HBO special exploring the consequences of unhealthy eating - which starts in childhood. 
The data is unequivocal: all calories are not created equal. Equal caloric consumption of broccoli versus soda cause different responses from the body’s hormones, metabolism, appetite and consequently -weight. 
Dr. Mark Hyman asserts, “Dinner is a date with the doctor. Food is medicine and what you put on your fork is more powerful than anything you will ever find in a pill bottle.”

The movie Escape Fire explores the special interests and financial incentives that keep our current healthcare system in place. Who benefits and why do they lobby so hard?
“Just the facts ma’am.” Both movies distill the issues down to the facts. Americans are unhealthy, heavy, and sedentary. Our diet is full of processed foods and marbled meats that have deleterious, long-term health consequences. Why do we continue feeding at this trough? There are powerful financial and industrial forces that benefit in largesse from the current system. Your health is not their concern.

What is healthy? As defined by the institute of medicine, “…attaining desired health outcomes that are consistent with current medical knowledge.” We outspend, by 3X per capita in healthcare dollars, the next developed nation. Are we 3X healthier? Hardly. Are we in the top ten? Negative. We have little national health to show for greenbacks spent. The facts say - moh kala ($$) maybe not moh-bettah. In other words, healthcare dollars spent does not confer healthy citizens. 
In the war for health, your doctor is unlikely to win the battle against convenience/fast foods, tempting confectioneries, over-nutrition, the food channel and a sedentary lifestyle. Current evidence points to a losing battle. If you have seen neither of the aforementioned specials, please do. They are time well spent that you won’t regret and a call to action.

While the ACA (Affordable Care Act aka Obamacare) is polarizing and divisive, it is nonetheless at the forefront of our national conversation - as it should be. America is in a healthcare crisis.
I have long been a supporter of the ACA though not without reservation. I come to it from a practical viewpoint shaped by 15 years in the Emergency Department (ED) and 35 years of nursing. I subscribe to the its like car insurance camp. E-v-e-r-y-one will need and receive medical care at some point in their life. If they don’t have insurance, they will seek care in an ED - at the highest price point and when they are in crisis.

I had a brief discussion with my 20-something neighbor.
“I don’t want health insurance. I’m young, I’m healthy and I don’t think I should be penalized for not buying it. And I don’t think I should have to subsidize a bunch of old people.” His is a common sentiment amongst the young and healthy.
Lets look at the facts (from the CDC = Center for Disease Control and Prevention website - 2012 data, published 5/2013). 130 million ED visits in 2010. “Persons with and without medical insurance were equally likely to have had one or more ED visits in a 12-month period.” From 2000 - 2011, consistent utilization of ED services was equally distributed among the 0-44 and 64-74 age groups. More utilization was seen in the 75+ age group (as compared to others) and fewer visits in the 45-64 years demographic. 
During that same period, the percentage of people 18-44 years delaying or deferring medical care related to cost, increased by 50%. The other age groups did not see that kind of rise. Why do you suppose that is? One reason might be that many of those younger and older are covered through governmental programs like Medicaid and Medicare. Additionally, the uninsured subset of this 18-44 years group were the heaviest users of health care overall. These are the uninsured working and non-working, women in their reproductive years, the entry-level fast food worker, the employees of Walmart. (Do not miss the irony of a multi-BILLION dollar corporation that offers substandard healthcare options to its employees.) 

Let’s get back to my young, healthy, working at an entry-level-job neighbor. He falls into the demographic (19-25 years) that historically experience high levels of uninsurance - around 30%. Motor vehicle related injuries and death are a significant for his demographic: males, 20-24 years. Given that he commutes to work on a bicycle, he is at increased risk of injury. Like most young adults, he needs a low cost, major medical policy that would cover catastrophic injury/illness. Without major medical, the tax payer would foot his bill because as a country, we’ve decided that no one should be turned away from an ED - care is mandated by law and MUST be provided. 
Without insurance, would we leave him to exsanguinate and die on the street? No. We would scoop and run to the nearest ED. That care can turn into a month long stay in a trauma unit after a motorcycle crash or a two-week recuperation after heart attack and bypass surgery. For the under/uninsured, those bills are paid by the American taxpayer. So if you think you don’t currently pay for the healthcare of others, think again.

You think its unfair to mandate healthcare? What are the options? 
1) Do we refuse to treat people without insurance? Turn them away or leave them on the street to bleed to death? Two years ago, a lightening strike in the remote Sierra foothills started a grass fire that spread to homes. One resident had a long history of opting-out of the optional, $75, annual fire service fee. When his house began to burn, he begged the fire service to save it. It was a difficult call; they did not help. He lost his home and promptly sued. 
2) Do we treat people and send them a bill? We do that now - "overwhelming medical expense" is the primary reason cited for the majority of personal bankruptcies in the US. The American taxpayer covers the shortfall. Is that fair? Our current system has been identified as severely broken. ACA is the first step of (hopefully) many to fix it. 
3) Do we cover everyone and mandate that they pay? The reality is that everyone IS covered through services offered in the ED and there, if uninsured, their bill is paid by the taxpayer. You see the conundrum?

In the last few decades, the incidence of diabetes worldwide has increased over 1000%. 1000%?! AND Type 2 diabetes is almost 100% preventable and nearly 100% reversible without medication or gastric bypass. In fact, over 90% of chronic diseases are related to bad choices, not bad genes. People do not decide their futures, they decide their habits and their habits decide their futures.  ~ Frederick M. Alexander 
Consider that when a government begins to control our healthcare, it will also begin to have a say in our health choices. And while we individualistic, cowboy Americans rankle at the thought, as a nation - we are not making good choices. Do we need big brother to hold our hand? The evidence would say - apparently yes.
Did you know that European nations have banned some of our junk food? Why? Because its JUNK, some would call it poison, and governments that foot healthcare costs have a voice in what their citizens eat. This will soon (and should) extend to school lunches. Travel abroad and you will notice that morbid obesity is an almost entirely American affliction. Clearly we are not making good choices.

While I am no a fan of Texas Senator Ted Cruz, he did speak the unspeakable last week. He chastised Congress for having a crème-de-la-crème medical plan that is unavailable to its constituency. As you know, the annual open enrollment period for healthcare selection has begun. Congress must decide which of its aides to toss into the ACA marketplace. Senator Cruz expounded on the moral code of a Congress that would deny its citizenry healthcare while funding an elite, comprehensive plan for itself. Bravo! The thrust of his verbosity was not to fund the ACA however, but for Congress to defund their own plan. I'll second that motion.
I have long tired of our Congressional aristocracy. The hypocrisy on the Hill is astounding. Let them dine with the proletariat! Let them retire on Social Security and buy their health insurance in the ACA marketplace. Let them live within the constraints of the laws they pass and fund. I contend that legislation would be more thoughtful and compassionate were they in our boat.

I worry the wave of Baby Boomers will overwhelm resources and completely bankrupt our country. What can I do? I can keep myself healthy by exercising daily, maintaining a healthy weight and using food as medicine. I can lead by example and encourage others to do the same - particularly my healthcare brethren. There is no more powerful example than being that which we proselytize to patients.

Most of you know I have a moderate degree of renal insufficiency (kidney malfunction). A decade ago I learned of my congenital anomaly (birth defect) resulting in a solitary kidney - and it is none too happy. It is undoubtedly the source of my infertility and other minor maladies. In kidney disease food IS medicine -  I eat a diet (mostly vegetarian) that supports renal health and have done so for approximately six years. Each year my blood work looks better, more normal, and each year slight dietary tweaking is requested by my Nephrologist. This year my potassium is a little low and phosphate a little high.
“So I’m looking again,” I explained over a recent beer. “I eat fruit every morning but I can’t eat citrus every day, the acid bothers my teeth. My fasting sugars are climbing too, so I need to be a little better at restricting carbs.”
“That’s so un-American,” my physician friend sneered sarcastically, “Why don’t you just take a pill?” We promptly busted a gut but his point is well made. Americans tend to manage symptoms with pills and surgery rather than attacking the underlying cause of most illness - poor diet and inadequate exercise.
As an aside, I ran into my former allergist on Friday - who once managed my four, daily asthma medications and frequent blasts of Prednisone. I haven’t seen him in three years because my asthma disappeared with my mostly vegetarian diet. I take no medications. This is not miraculous, its well steeped in science.

I am in my fifth decade of life and nibbling at the sixth. Lifestyle has caught my cohort and almost everyone is learning to two-step with a chronic disease. We call them chronic because for most people - they will be. But they don’t have to be. There is another way. Interesting to me that our national health dialogue does not include a broad conversation about vegetarianism. Follow the money. There are powerful interests and billions of dollars invested in keeping the status quo, status quo. And the status quo is not necessarily in your best interest.
Educate yourself: Start by watching Weight of the Nation and Escape Fire. Do something drastic. Pry yourself from the disease of denial and seek support to make appropriate changes. Don’t go it alone. If you were reliable to produce the result you want without support, you would already be there/have that. (e.g.-You would be at your ideal weight and perhaps have shed diabetes and blood pressure medicines.) Never-mind what didn’t work before. You are not the same person you were a decade ago. Try it again. Research shows that those who try, try again eventually succeed.
If you always do what you’ve always done, you will always have what you’ve always had. Make a change. Start with Meatless Mondays, Fish Fridays and eat five fruits and vegetables each day. If you eat fruit with breakfast and salad at lunch, 3-4 of your fruit/veggie requirements will be satisfied. Its different - not difficult.

Who I am is vitality at every age and any stage 
- for me, for us, for all of us. 
~ Ask me how.