|Read Part One|
Outside the window of the office — the office of Pagosa Springs Medical Center CEO Brad Cochennet — it was winter. Cold, snowy, frozen. A time to bundle up, to try and stay warm.
Inside the office, administrative coordinator Kelly Johnson was speaking with some passion in her voice. She was giving me a history of an innovative wellness program at the medical center — noting that “wellness does not pay.”
Does not pay the bills, she meant.
“Poor diet and lack of exercise, the two main contributors to — say, heart disease, the number one killer in both men and women — but there is no reimbursement for prevention programs from insurance — they won’t pay for it.
“So Brad and the board — when they look at it from a purely financial viewpoint — they are better off not showing people how to prevent heart attacks. Because eventually, that person will end up in the Emergency Room, and the District will make money on them.
“But that’s not the approach they took. They said, you know, ‘What’s the right thing to do?’ The right thing to do is to educate people on how to eat right, and how to exercise. And give them motivational tips along the way, to help them change their lifestyle.
“We’ve had so many people come to us, and we’d say, ‘Well, your LDLs are really high, so we’re going to coach you to do this and this. If you can lose just 10 percent of your body weight and start exercising two times a week, you are going to see a drop in [your LDL levels].
“We can get them to do some of these things, through coaching. But when we’d call them three months later, just to check in on them, we’d ask, ‘So, are you still doing your exercise program?’
“And they’d tell us, sounding very apologetic, ‘No, I’m really meaning to.’ And we’d ask if they’d added more fruits and vegetables to their diet, and they’d say, ‘No, I just don’t know how to cook. I don’t know what to cook.’
“So from that experience, we began to say, ‘Well, let us teach you how.’
“We are still not breaking even [financially] — the program is partially funded by a grant — but if I can get in there and change your behavior, and if you can change your family’s behavior, and your kids go out and change their family’s behavior.. one day, we have changed the whole community of Pagosa Springs. Just from this program....”
Back in about 400BC, a Greek physician named Hippocrates spent 20 years in prison for suggesting that diseases resulted from “natural causes” — by incorrect diet, lifestyle excesses, or poisons found in the environment — rather than as punishments handed down by the gods. This sort of teaching did not make him popular with the more devout Greeks of the day, who preferred to give credit to the supernatural beings living atop Mt. Olympus.
Hippocrates is sometimes referred to as “the Father of Western Medicine” and is credited with coining the Hippocratic Oath, which originally went like this, in part:
I swear by Apollo, the healer… I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. But I will preserve the purity of my life and my arts.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal....
in a collection of books known as the Hippocratic Corpus, probably written either by Hippocrates or one of his students, we find the somewhat famous teaching:
“Let food be your medicine — and let medicine be your food.”
Americans nowadays seem more likely to subscribe to the second half of that famous quote: “... let medicine be your food.” Kitchen cabinets — once meant to contain cooking pots, cups, plates, spices, and various ingredients for home-cooked family meals — are nowadays just as likely to contain various and sundry pharmaceuticals, pills, vitamins, appetite suppressors, liquid supplements, and other “medicines”.
We might note the first half of the quote: “Let food be your medicine...”
This half of the quote has been vigorously promoted by Western nutritionists for centuries, and also forms the basis for medicinal practice among many Asian cultures — traditional Chinese medicine, for example, and the Ayurvedic system in India. But here in America, nutrition-based medicine is today referred to as “alternative medicine” — as an “alternative” to the high-tech world of synthetic drugs, radiation treatments, and surgery.
But what Ms. Johnson was referring to is not medicine, perhaps? Preventing disease — through healthful lifestyles, diet and exercise, and environmental regulations — does not normally fit into the “health care” system here in America. It’s not really considered to be “medicine.”
“Medicine” is what happens after you are already sick.
And it’s pretty darned expensive, here in America. According to a 2009 news report developed by PBS, America spends about 16 percent of its Gross Domestic Product (GDP) on health care. That compares with countries like Japan and Finland — which, according to the World Health Bank, have superior health care but spend only about 8 percent of their GDP on medical expenses.
If you average out the cost of health care in the U.S., we each spent about $7,540 in 2008. In Japan, the expenditure was about $2,730.
As this chart (from the Kaiser Family Foundation website) shows pretty clearly, the cost of health care is increasing all around the globe — but is increasing at a much faster rate here in America than anywhere else.
Notably perhaps, Finland spends about 1.3 percent of its health care dollars on “administration.” Here in the U.S., we expend about 7.5 percent of our money on “administration.”
Our per capita health care costs here in the U.S. were less than $500 per person back in 1970 (PPP adjusted.) Today, those costs are about $7,540 per person. Do we perceive a problem here?
The question facing us here in Pagosa Springs is, of course, what can we do about the situation, right here in our own backyard?
Should we expand our medical center, at a cost of many millions of dollars? Is that the best route to better health?
Read Part Four...