If you are stuck at a traffic light and there’s an allopathic doctor in your car, he will sell you a little hammer to knock out the red light and after the accident he will happily patch you up, all the while feigning utter surprise and ignorance about the causes of your condition.

From: Reinoud Fentener van Vlissingen, MD, ca. 1967.

The following is just a draft of what I believe should be the healthcare model of the future, along with some commentary of why it addresses the problems we presently have. The quote above was from my psychiatrist father, when I was in my teens, so at least since that time I have been focused on the idea that Western medicine, for which I now like to use the pejorative of #pharmageddon, is a completely bankrupt model, because it treats symptoms and does not heal patients.

A new model for healthcare will need to take into account several issues in terms of providing the right economic incentives:

The emphasis needs to shift to the patient taking primary responsibility, through prevention and/or disease reversal with Lifestyle Medicine, i.e. a Whole Foods, Plant-Based diet.
This must include a combination of self-assessment à la the 4Leaf survey, as well as labs.
Particularly in the personal care area, the focus comes on the patient taking responsibility and being willing to implement the necessary lifestyle changes.
Compensation needs to shift to outcomes more than pills and procedures (treatments) wherever possible.
By making the PCP a personal health coach whose allegiance is to the patient directly (even if through a mutual society, as proposed below), the tendency to overtreat will be reduced and any malpractice issues will be handled professionally right from the start, and most likely avoid frivolous suits and be settled quicker.
Bookkeepers will be largely eliminated from their current roles in rationing care in the conflicted healthcare model of today.
Society needs to come to more clarity that health and well-being is primarily about quality, not quantity, of life. Gaining a few more breaths at the end of life in a suffering body for a million dollars is not healthcare.

The Failure of Failure

Pharmageddon to me is a technical term meaning a form of medicine that prioritizes treating symptoms over cause, and therefore results in spiraling medical inflation as illnesses tend to progressively deteriorate as long as the cause is not being addressed, while the symptoms are being “managed” at a cost of increasing amounts of pills and procedures, resulting in staggering amounts of life-time medical billings.
A simple example is a heart patient. The first symptom might be ED (in men, obviously), sometimes as early as in their 20’s. A whole foods, plant-based diet might reverse the condition, often in less than a week. But medical treatment (Viagra, etc.) causes the symptoms to be suppressed and the cause to remain unaddressed, producing what could ultimately be $5 million life-time medical billings.

From: I said that.

Our health care system is a failure for the simple reason that it fell into the trap of: if you have a hammer, everything looks like a nail. Just because drug therapies were successful in infectious diseases, does not mean they are the best tool for the chronic/lifestyle diseases that dominate the scene today, such as heart disease, diabetes, cancer, and others. Fully 85% of expenditures are on the treatment of chronic illnesses that do not yield to pills and procedures, but respond well to a whole food plant-based diet. Read: they can be prevented or reversed, as in:

CardioVascular Disease (CVD), probably 95% or better – the first symptom in men is ED and can often disappear in days after people change to this diet.
Type 2 Diabetes, probably 80% or better and markedly improved prognoses in many Type 1 cases, resulting in reduced treatment plans.
Cancer: at the very least improving prognoses in nearly all cases and complete reversals in some, c.f. Chris Beat Cancer.
Rheumathoid Arthritis, Multiple Sclerosis, Asthma, on and on. According to some stats it boils down to 37 of the top 40 leading causes of death can be thus prevented and/or reversed with diet.

The healthcare system is much under discussion these days but what is actually happening is that pharmageddon is digging in by making itself cheaper in order to keep customers coming back for life. So these days insurance companies are sponsoring “urgicare” in order to reduce expensive ER visits. All urgicare will do is write prescriptions and enroll people in the disease management system cheaper, thus doing effective patient acquisition for a system in which doctors, hospitals and pharmaceutical companies make their money on our being sick, not healthy.

In other words, urgicare is a symptom of the failure of effectiveness of the primary care network. The urgicare system is a cheaper, more efficient method of patient recruitment, to capture future customers for a system that pays for treatment not for healing and wellness. The urgicare system is the equivalent of the little hammer in the quote above, it is a form of early triage – quick symptom suppression that allows the person to go on with all the unhealthy behaviors and allows the underlying illness to progress – creating better customers for the future. The apparent justification of urgicare is to keep costs down on the presumption that the pharmacological answer is the only answer, and certainly not the problem, when in fact the opposite is the case. This is an example of bookkeepers figuring out a solution to healthcare, and that is exactly what is wrong with our system. We’re just making it cheaper to do the wrong thing and postponing the reckoning. In the process we effectively ensure returning customers for a long time to come. Because the system is driven by the need to treat. Treat earlier, treat longer. Just like the illegal variety of drug dealers, you want the customer coming back.

Lifestyle Medicine is the Answer

Healing occurs as a patient begins to hear the dirge he sings, and questions its validity. Until he hears it, he cannot understand that it is he who sings it to himself. To hear it is the first step in recovery. To question it must then become his choice.
From: Psychotherapy: Purpose, Process and Practice

The primary care network is itself a failure for the above cited reasons, but change is starting to happen in terms of the emergence of lifestyle medicine, supported by a budding interest on the part of health plans in paying for results not treatments. A lot of motivation for change is coming from patients, but importantly also many doctors are fed up with being mere pill pushers, and unable to help in healing. The rapidly growing specialty of Lifestyle Medicine restores professional dignity and meaning to doctors as much as it helps patients regain quality of life by preventing and reversing the chronic diseases that now consume 85% of healthcare spending and are out of control because pills and procedures are largely ineffective for the purpose, and should be used with much more reticence.

Famously, an ounce of prevention is worth a pound of cure. And Lifestyle Medicine is the medical practice that is anchored in the insights of the Whole Foods, Plant-Based nutrition. Anyone who is interested in these development should join the American College of Lifestyle Medicine.

The Holistic Approach

T. Colin Campbell’s book Whole defines the new paradigm from a nutritional standpoint, but the principle applies to all of medicine. The willingness of the patient to heal and be healed is the absolute conditio sine qua non of the healing process, but the effectiveness of the process requires a holistic approach. The currently dominant reductionist paradigm focuses on symptoms and the “improvement” from a given nutritient or pharamaceutical or other treatment, but this leads to erroneous conclusions more often than not.

The types of examples Campbell cites include such information as the fact that vitamin C as obtained from an apple, is provably 265x more effective as in the form of supplements, because of the whole nutritional matrix. This is ultimately why, in the case of almost all chronic illnesses, the first thing to do is to do the maximum possible that can be achieved with lifestyle modifications to enable to body to heal itself, before any medicine is even considered. If the situation is critical, some medical therapies may be needed for a while, but the experience is growing that often times medical treatment can be avoided altogether.

It should also be evident that the misplaced reliance on allopathic treatment, which is effectively a monopoly in America today, is in and of itself the cause of medical hyper inflation, since we are trying to do with nails what can only be done with screws – to the tune of 85% of health care spending in total being wasted. See the upcoming movie Code Blue.

Especially when you take into account the insights of Joe Dispenza’s You are the Placebo, and Amit Goswami’s The Quantum Doctor, it becomes evident that the mind of the patient is the healer, and the doctor is at best a midwife for the healing process. Therefore, one of the issues at hand is also that other treatment modalities, subject to reasonable validation, have as much of a role to play as allopathic medicine, which will lead to a wholesale reframing of the notion of specialist care – the key being what works for the patient. In Holland there is a far-reaching initiative under way and there is a website where you can find some of the fundamental information, titled Health Mastery.

At yet a different level is the focus on consciously making the choice for health and healing, and for that, I recommend Cindy Lora-Renard’s book, A Course in Health and Well-Being. Ultimately, the willingness to heal and be healed is the absolute first step. This is well understood in psychotherapy, it applies to all of healthcare.

What health plans should look like

The following model seeks to align healthcare more with the patient and avoid the financial conflicts of interest that are rife in healthcare. I am publishing it here, since it is an alternative that I think is worthwhile but I have not seen it anywhere in these terms.

Primary Care

Your primary care physician should be a Lifestyle Medicine certified doctor and your personal health coach. Since the emphasis here is on prevention and reversal of disease with lifestyle modifications, the responsibility is 85% the patient and 15% the doctor, but the doctor becomes the subject matter expert in the team, both in helping you to keep your lifestyle on track and in advising you in finding other healthcare services (specialists) if need be.

Some points:

The best approach is probably a mutual society of primary care lifestyle physicians with the patients as members, and able to address patients who travel with effective healthcare records. The reason for a mutual society is that it is not-for profit, the members are the owners. The critical part to getting that right is creating the management structure.
It will be desirable to a much more liberal use of other healing modalities, such as naturopathy, homeopathy and others, as long as the primary focus is on lifestyle medicine first, and the training should be such that a naturopath or a homeopath are an MD first – again they need to be your subject matter expert in navigating healthcare.
Both self-assessment and (at least) annual checkups should be combined to help the patient achieve and maintain optimal results in all the usual parameters, and probably a few more that are not now routinely done, such as the screening for the intestinal biome, which is powerful complementary data in ensuring the patient is on track with their diet and lifestyle.
Some basic physical therapy might belong in this layer, expecially if it is mostly of the DIY variety.
Some psychotherapeutic assistance should fall within the primary care system, as far as assisting patients in addressing their own self-sabotage where it prevents healing.
Some minor prescription services might be part of this level, for some things may need support of a drug therapy, or
Instead of today’s idea of a deductible across the board, this part should be paid for by the patient as a subscription service, and this can be further supported with a tax credit as necessary.
The mutual society should have lawyers and other subject matter experts on staff to help the patient get second opinions and other forms of supervision if they should ever need more extensive healthcare services. If there is malpractice at that level, the mutual society should prosecute the cases on behalf of the patients.
As a practical matter this first step could be made universal with a combination of tax deductability or tax credits, but it needs to be personal, not done through an employer or the state.

Specialty care, hospitalization

The next layer is for everything where lifestyle medicine and healthy behavior do not help: accidents, infectious diseases, surgeries, and so on, this is insurance proper. This is the actual insurance plan and it should probably be a national plan and we should get away from having bookkeepers ration healthcare. This could be in part employer funded with some ability to offer optional extras and, most importantly, some rate discrimination for lifestyle choices. The current system of tax incentives for employers is fine for this tier.

A recent presentation on the workings of the UPMC (University of Pittsburg Medical Center) by Dr. Michael Parkinson, MD, MPH, FACPM, of P3 Health, under the title of the Healthy Healthcare Work Place, showed that they are already well ahead in their ability to sort out the actuarial data related to lifestyle choices. In short, eventually, it seems unavoidable that people who smoke or eat meat will pay higher premiums.

Catastrophic care

This area should include all forms of catastrophic care, including major epidemics, natural disasters, and the infamous “pre-exisitng conditions,” as well as catastrophic long term care, which have nothing to do with insurance. Alexander Marchand dissects very eloquently in a blog post why this is so: On Forgiving U.S. Healthcare. It mostly needs to be dealt with as some sort of welfare, probably still via a tier of Medicare/Medicaid, as always with personal options for improved coverage.

However, it should be noted that also here the consistent introduction of a whole foods, plant-based diet is likely to sharply reduce the demand for these services. As my old dentist used to say: “People used to have an immune system, you know.” We can get back there. There can be service tiers for those who refuse to do their part.

Conclusions

If ultimately 85% of health care dollars are misspent on pills and procedures, the opportunity exists to ultimately shift some 75% of that burden to diet and lifestyle, with only a modest need for medical support, and probably an 85% reduction of medicines that “You will have to take this medicine for the rest of your life.” A 75% reduction of this largely avoidable 85% means a 63.75% reduction of overall healthcare spending. We have got our work cut out for us, but it appears achievable.

Part of these observations overlap, but they also go beyond the work of Health Rosetta, and whoever wants background information, I can recommend Dave Chase’s two books, The CEO’s Guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost, and The Opioid Crisis Wake=Up Call: Health Care is stealing the American Dream. Here’s how to take it back.

In short, healthcare reform is more than just the administrative part. Rationally, a single payer system should be more efficient, but the real long term economic improvement lies in what is suggested here, enabling people to avoid that 85% of misspent healthcare dollars by lifestyle choices, and building a system to support that.

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Health, Healing, Well-being and the Healthplan of the Future