How to save money while improving our health

With historic legislation that went into effect  March 2010, 32 million legal residents of the US should now have health insurance of some kind.

This is wonderful but it does nothing to address the question of what eats up to $ 2.3 trillion or 16% of our GDP. Here are some of my ideas about things that we can do to reduce cost without compromising quality.

1. Focus more lifestyle issues like nutrition and physical activity
In the United States we spend around 10% of our income on food. In the rest of the developed world it is closer to 20% (and in places like India, it might be as high as 50%).The ample availability of  inexpensive high-calorie food does not mean that it is nutritionally complete. Why is it that we spend more on medical care than we do on food ( and its the other way around in Europe and Japan)? Couple that with our sedentary lifestyle, and we have a lethal combination. We would do a lot better with a more plant based diet and 60 minutes of physical activity a day than by taking more pills to prevent health problems. Putting healthy people on Crestor ( at $3.50 a pill) is unlikely to be a wise move.

2. Tort reform
Defensive medicine results in testing worth millions of dollars simply because a doctor who has been through the harassment and humiliation of a lawsuit spares no expense not to go through the same experience again. And yet Obamacare does nothing more than lip service to address this issue.

3.Comparative effectiveness research
Figuring out which treatments actually work and sticking to those can save us millions. But there are numerous vested interests in promoting expensive interventions that add little or no value. Research may not be enough to change attitudes shaped by years of brainwashing by aggressive marketing.

4. Creating more accountability
By rewarding healthy behaviors and discouraging unhealthy behaviors, we need to foster more individual accountability for our own health. Insurance is good for catastrophic illness. Consumers need to have "more skin in the game" in decisions about fancy imaging tests and generic vs. brand name drugs so that we can all be more responsible stewards of shared resources.

5. Aligning consumers, providers and the money managers ( insurance companies)
There is often a disconnect between the patient-doctor partnership and the hospitals and insurance companies because of conflict of interest. For example, the patient and doctor might want a longer stay in the hospital but the hospital makes more money from a shorter length of stay.


6. Focus more on wellness
By encouraging people to take better care of themselves: be it by meditation, hypnosis, biofeedback, massage we can build more resilience and better health. We need to shift the focus to self-care: that is the essence of health.

7. Stop looking for nails just because you have a hammer
Over-treating either at the end of life is inhumane and expensive. Medicalizing normal conditions by changing the definition of normal is a deceptive way of selling more drugs or tests. Suggestive advertising has created new diseases and syndromes out of everyday experiences stemming for lack of self-care.

Innovate or Go Extinct

The number of cosmetic-surgery procedures in the U.S. sagged for the second year in a row in 2009, according to an annual survey released by American Society for Aesthetic Plastic Surgery. There were 10 million surgical and nonsurgical procedures in 2009, down 2%from 2008.

Breast augmentation was the most popular surgical procedure for the second year in a row. Breast augmentations numbered 311,957 last year, down 12% from 2008; liposuctions numbered 283,735, down 17%.

Nonsurgical procedures, such as injections of Botox or hyaluronic acid to fill facial wrinkles, were flat, inching up 0.6% to 8.5 million.

Meanwhile in India, Singapore, and Thailand, the cosmetic surgery business is booming. They have an already enormous and still expanding population of wealthy people who are willing and ready to spend their wealth on improving their beauty! Which means surgeons there are really perfecting their skills.

These locations are increasingly becoming a mecca for elective surgical procedures at a fraction of the US or Europe cost. Bumrungrad hospital in Thailand; Fortis, Wockhardt and Apollo hospitals in India are globally accredited and staffed by highly acclaimed ( and US Board Certified) physicians who have world-class outcomes.

And there are numerous outfits selling packages which include a surgical procedure with a 3 week convalescence vacation at really attractive prices. Medical Tourism is a reality in 2010.

But here is where it gets really exciting: A number of Indian hospital chains are in the process of setting up shop in Mexico. These hospitals will be manned by internationally credentialed staff. Once they are up and running, they are going to give us a run for our money!

Thomas Friedman is right. The world is getting smaller! Globalization means what goes around, comes around.

Only the smartest, leanest, and most innovative will survive.

First Lady is smarter than Prez!

Michelle has decided to take on the issue of childhood obesity. Probably a much more meaningful approach to attacking the issue of sky-rocketing health-care expenses in this country. Obesity is the root cause of the epidemic of type 2 diabetes, high blood pressure, heart disease and strokes. It is increasingly being implicated in more and more cancers as well. With the majority of spending stemming from cardiovascular and cancer care, it makes perfect sense that by focusing on obesity, we can make the deepest long term impact on the health of this nation.

While watching the super-bowl with my teenage boys last Sunday, I was guiltily shocked by how I would crave Doritos, Budweiser, Coca-Cola and whatever other crap I was shown catchy ads for. These ads must have been created by psychologists and hypnotists who knew the inner workings of every neuron and synapse in my brain and secretly knew how to short circuit all my intellect, wisdom and will-power. I was getting a headache from my frontal cortex trying to fight the brain-stem impulse to run to the kitchen and devour every bright red and yellow colored package that I could find in the pantry.
And if the average American child is watching 4 hours of TV a day, then Mrs Obama has an uphill task ahead of her. She has the lobby of the processed food industry against her. And against her are 47 million innocent daily fast fooding eating people who will fight to defend their freedom of choice, their right to pursuit of happiness!

I wish her Godspeed.

How do you want to die?

Most of us would like to have a long health-span: being highly functioning, mentally and physically active, strong robust individuals and then when it comes time to checkout, to rapidly fall apart and evaporate.

In reality, a lot people in the Westernised world work till their mid-sixties and then very slowly and painfully deteriorate with creaking joints, failing memory and senses, slowing intestines, limp genitals, winding up in the nursing home for a few years followed by the ICU for a few weeks or months, and from there on to the grave.

What if we could increase our health-span by a few decades? Not necessarily to live longer to but to post-pone the decay so that it starts later?

This is the promise of regular exercise, calorie restriction and stress management. By being physically active and eating only till we are 75%-80% full and managing stress, we can surely push back the decline. Add a little omega 3 fatty acids, Aspirin and vitamin D, and now we may be onto something! Early studies with Resveratrol ( from the peel of red grapes) are showing promise for potentially powerful benefits.

And when it comes time to check out, bidding farewell with a big bang and a smile would make for a happy ending after all!

The organ transaction

It was just a couple of a weeks ago that my friend went to sleep never to wake up again. Having died suddenly but peacefully, it was time for his wishes to be fulfilled. He had asked to be an organ donor and indicated his wishes with a little pink sticker on the back of his drivers licence. It was then that his family realised what this meant. While coping with the painful reality that he was not coming back, they also had to assign one full-time person to answer the incessant ringing of the phone from interested parties calling for his organs: everything from his eyes to his heart, lungs, liver, kidneys, pancreas; even his bones were in demand! After all, he had been a healthy, vibrant, energetic productive member of society just hours ago!
And today, I met another family whose son received a kidney-pancreas transplant 2 weeks ago. They were so pleased that after 5 years on dialysis and several false-alarm calls, they finally found a donor that miraculously "hit the spot". It was a near-perfect match and they felt like they had won the lottery! They were elated that their son did not have to be on dialysis any more!
Although I don't know if the organs their son received were ones whose original owner had been my friend or not, I could not help wonder if this transaction ( for lack of a better word) could have been a little more humane for the donor.
But then, he is the lucky one who gets to live on long after his death.

Does aerobic exercise help you lose weight?

I was appalled by some recent press articles saying that exercise doesn't help you get thinner because after exercising, you tend to be more hungry and are also more likely to eat richer foods because "you have earned them".
While this may be true to some extent ( as evidenced by the numerous occasions that I have pigged out after running a half-marathon), the health benefits of exercise are too numerous to even begin to recount. Exercise produces endorphins which make us feel happier, exercise increases circulation to all parts of the body from the brain all the way to the feet. It helps keep the joints well lubricated. Exercise improves lung capacity, boosts the immune system and help develop and stronger, more robust blood supply to the heart muscles. It stimulates the digestive system to more effectively assimilate nutrients and excrete waste. Sweating removes toxins too. In addition, it helps strengthen the bones and promotes stronger muscles, hence increasing lean body mass.
And this increase in lean muscle mass is how it can help us lose weight or maintain a healthy weight. Thinking about exercise in terms of calories burnt is a rather foolish way of over-simplifying something that is much more involved. Even if you eat more calories than you burnt during exercise, the additional lean mass is going to boost your metabolism so that your body is burning fat even as you sleep.
SO...stop reading and go for a walk!!

Do you feed your dog Diesel fuel?

High fructose Corn syrup( Hfcs) has revolutionised with food processing industry by providing an unlimited supply of cheap sweetener. If you read the label, you will find Hfcs in just about every sweet food or beverage you can buy at the grocery store ( by the way, did you know you have 40,000 choices the moment you enter a medium sized supermarket?).

Here's the kicker, Hfcs bypasses ( effectively flies under the radar) of the normal satiety mechanism. In other words, your taste buds don't get saturated with 40 grams of sugars in Hfcs as they would with 40 grams of crystalline sugar. Futher, you could potentially keep eating an enormous amount of food sweetened with Hfcs without the brain's fullness sirens going off.

The reason for this is that your brain does not recognize Hfcs the way it does more conventional foods which have existed in nature for millenia.

SO, next time you get ready to put something in your mouth, think about whether or not your body would even know what to do with it ( is it something your great great grandmother would know of)? The greater the number of steps between the soil and your plate, the higher the likelihood that this food is going to wreak havoc on your insides.