Ten years ago, I was a reporter for a major medical news company, and I logged a lot of hours covering socioeconomic issues in medicine. The Clinton administration had just unveiled its plan to reform the health care system. Mr. and Mrs. Clinton argued it was simply unacceptable that the wealthiest, most advanced nation on Earth had more than 30 million citizens—most of them active and working—who could not afford health care coverage.
Those were dizzy days for medical reporters. Like you, we suddenly faced a new lexicon: utilization review, RBRVS, capitation, gate-keeper, risk pool, preferred providers, cherry-picking. Clinical science took a back seat to social science.
The Clinton plan quickly hit the rocks of partisan politics and economic special interest-ism. In all honesty, it was a questionable plan. But whatever one thinks of the Clintons, politically or otherwise, they did put health care issues on the national agenda. Back then, most political and industrial leaders didn’t seem too worried. Managed care was going to save the day. Somehow, HMOs were going to cut costs so everybody could afford coverage. They would standardize care, institute “best practices” so everyone would have optimal “health maintenance.”
Most of you knew better. So did some of us. But those in office preferred to keep their heads in the sand. After the Clinton plan sank, few elected officials were even willing to mention “health care” in polite company.
Ten years later, I read the health care headlines and all I can do is shake my head. Over 42 million uninsured Americans and growing. Frustrated physicians staging walk-outs in many states. Employers cutting health benefits. A Medicare drug “benefits” plan so complex only a veteran CPA will be able to figure it out. Major health insurers under investigation for accounting fraud. Major drug companies under investigation for unscrupulous marketing practices.
And underneath it all, a massive wave of chronic disease: 129 million Americans overweight or obese and on the fast track to CVD. One in five Americans diagnosed as hypertensive. Nearly a million CV deaths each year, 250,000 of them outside of hospitals. Roughly 17 million diabetics, most with type 2 and many under age 25. Nearly 4 million with hepatitis C and a million with HIV. Seventy million adults and 300,000 children living with some form of arthritis. You know all the numbers. You also know all the faces. You know the despair.
Despite the soaring costs, the pharmaceutical and biotech companies continue to roll out ever more powerful, potentially toxic, and costly drugs that fewer and fewer people can afford.
I won’t claim holistic medicine has all the answers to the nation’s health care woes. Nor do I think it wise to jettison the search for better pharmacologic therapies or acute interventions. But the preventive philosophy, whole-systems thinking, cost-efficiency, and non-invasive orientation underlying holistic medicine could go a long way in lightening the burden of chronic disease.
Representatives of holistic health care were absent from the health care reform debates a decade ago. But as the nation collectively wakes up and realizes it can no longer ignore the health care crisis, I hope the voices of a compassionate, scientifically grounded and confident holistic health movement will echo in the halls of power. The current system—if we’re generous enough to call it a system—does not work for too many people. You, as physicians, must speak up. For yourselves and for your patients. A lot is at stake.
