Life expectancy has increased from age 42 a hundred years ago to near 80 years today. This increase came from the advent of vaccines to prevent fatal, if not health destroying, infectious epidemics, the advent of antibiotics and antiseptic technique, aspirin, morphine, the modern surgical and medical centers and teaching and research hospitals, improvements in the safety of our work and home environments, improvements in mental health treatments, dental care, and improved nutrition.
Remarkably, this tremendous feat of the last century was accomplished while swimming against the current of new disease risks that came with our richening society. These major “undertows” and detractions from further increase in life expectancy are the explosive increase in heart and vascular disease and frightening surge in cancers. Together, these diseases account for nearly 60 percent of all deaths. More recently, it is becoming clear that the prognosis for further improvements in longevity is being greatly “weighed down” by the epidemic of obesity, with its myriad of contributions to multiple premature aging illnesses-including playing out as a major risk factor in the development of our two major killers. Of course, our cultures obsession with tobacco continues as another “brick wall”, hindering our further progress.
“Progress you say, what is progress?” If you go around talking about how Boomers can plan on adding 20 years to their life with all of the preventive health measures becoming available, or tell your kids and their friends that their predicted expectancy is 120, the most common and large majority response you’ll get is “I don’t want to live to be that old, who would want to live that old?”. Try it and you’ll see it’s the case. While you may get a different answer in Hollywood, California, its certainly what you’ll here in Ohio. What’s the problem? In addition to our culture having glamorized youth, images of nursing home life are fairly frightening. Most of us have an expectation or certainly are prepared to accept significant reductions in vitality, health, and even death in family members and friends who are 65 and older. Although most of us know of exceptions, very few of us interact with healthy and vital persons over 85. Instead, we see this period as the expected period of steady decline in health, where various ailments can dampen one’ days, and that on any particular day your candle might be suddenly snuffed out. In fact, little known outside of the circle of physician’s who study aging, we do have a major longevity “barrier” at 85. In other words, current research suggests that overall cellular aging, either through various damaging mechanisms such as oxidative stress or through genetically programmed or linked cell death, force us to an average, maximum, goal, life expectancy of 85. The hope is that this number will increase significantly with the advent of telomerase inhibitors that lengthen the DNA life of cells, gene therapies, or with more currently available synergistic cell health benefits that appropriate antioxidant therapies, nutrient supplements, and hormone maintenance might provide. It's really amazing to think that we’ve moved so close to this predicted, maximum, average life expectancy of 85. Yet, it’s understandable that people don’t want to extend that portion of their life past 65 that they have rightfully observed as a period of decline, suffering, or possibly worse- senility. Although many health enthusiasts are on board, the average American is not aware of or currently capable of taking advantage of the fact that aging researchers and longevity physicians believe that the steep, steady decline in health and vitality that becomes so apparent past 60 or 65 in our population, can become a decline that does not become significant to just a few years prior to age 85. “Youthful Aging”, “Forty Forever”, “Forever Young” have been a few of the rallying cries of authors and proponents of longevity medicine. Since aging can be defined as the onset of multiple disease processes, it is clear that preventive medicine steps taken to prevent the various diseases will prevent many of the premature ravages of aging. With a comprehensive preventive medicine program, each person can add up towards 20 years increased healthy, vital years to their life. To put it another way, we can stay the biological age equivalent of 40, 50, 60, 0r 70 until we’re a chronological age of 80 or more. There is significant societal, lifestyle, and financial barriers to be removed before the average American will receive these benefits. But, if you don’t mind, I’ll take my twenty now! I hope you will join me and help your family and friends gain the same.
The Problem Presents the Solution
It has become clear that America has been backed into a corner in several ways related to our health. There is a major crisis in our country as far as health care and health care insurance costs. This is much publicized and much talked about. It is a horribly sore subject with small business owners who feel they will lose valued employees if they pass on the 20% or more per year hikes in premiums to their employees, it is the dread of a majority of retirees on fixed incomes who are suffering from broken promises from their previous employers in the way of huge, unanticipated, out-of-pocket expenditures to continue their health insurance. The crisis is a source of national shame with 40 or more million uninsured citizens placed in a “have not” class. And, of course, the epitome in fodder of political ambition and debate is embodied in the crisis of our elderly not being able to afford their medicines.
In looking for the cause of our crisis, exploring the model that, “in America, we are victims of our own success” is illuminating. As Americans, we have come to expect a lot. We expect to be pieced together and patched by the medical field until that day we can puff, imbibe, or desert no more. The genius, ingenuity, ego, and money of our medical system has both fostered and been propelled on by our expectations. And, it looked like we were going to be able to afford it! But, there’s been a terrible convergence of trends that can be considered the “Perfect Storm” that’s causing our health care boat to take on water fast. The illness-laden, stubbornly reluctant aging of the Greatest Generation has run into the storm of demand coming from the aging Boomer population. Both storms have been strengthened by excessive energy coming from an ocean boiling with myriad of spectacular life enhancing medicines and medical procedures. The winds of each storm had stirred enormous with the excesses in lifestyle of each generation that came with America’s escalating wealth. And, then, our health care boat suffered design flaws that allowed 40 million to be washed overboard as it continued to take on water. Various system component failures- particularly the HMO engine which was supposed to prevent the boat from sinking with implementation of effective preventive medicine, threaten to capsize our health care program. The fact is that our boat design is top-heavy with secondary and tertiary illness prevention emphasis, rather than primary preventive interventions that would have cleared the deck of crowded passengers. In other words, the high cost of medicine today is because we are not successful in preventing heart disease, cancer, stroke, lung disease, and diabetes by low cost primary preventive steps such as weight control, smoking cessation, diet adjustments, exercise the need for top-heavy secondary and tertiary preventive medicine measures, while clearing the deck of crowded passengers with comprehensive implementation of aggressive primary preventive measures. We’ll need a new engine to replace the HMO design. Whereas medicine has done so much for America in the last century, a dramatic shift toward primary preventive medicine will break us out of the corner we’re stuck in and provide much more promise for medicine in this new century. All medicine is preventive medicine, in that it prevents or eases death. The problem has been that forces have shifted our focus and overburdened us with costs of the secondary and tertiary components of preventive medicine. The solution is redirecting our focus in preventive medicine to the primary preventions.
Forces, Factors, Phenomena, and Opportune
Screaming for Change
The economic crisis of health care affordability and access is a major force crying out for change. To most Americans who have insurance coverage, the stress of this force has likely been felt in increasing monthly outlays for their insurance or portion of their insurance- 5 to 10 times the rate of inflation over the last 5 years, while at the same time finding increasing co-pays on prescriptions or suffering denials of coverage of care needed or received. This is a highly negative force in terms of stress on individuals and our society. It means we must work harder, or give up leisure items, in order to pay. Or, we might simply be forced to go without care. The long-term consequences of this crisis, considering it will decrease the average American’s seeking out appropriate health care, can potentially be enormous in terms of worsening health of our population and further added costs loaded to expensive secondary and tertiary health care measures down the road.
Our country’s economic momentum, in general, is one that still rides the backs of the middle class, lower middle class, and poor. In addition to the loss of the pension plan promise in America, the looming failure of Social Security, and continued increased demands on each worker; we seem just as destructively short-sited in not recognizing that increasing the health quality of our workers could pay huge dividends in increased growth, productivity, and blunting of the negative impact of these other trends. We’ve ridden to great heights on the improved health of our worker’s, and we are threatened with a reversal of gains by overstressing and inadequately providing preventive maintenance for the workforce.
A critical factor in looking at a shift toward primary preventive medicine is that medical knowledge is exploding. It is calculated that medical knowledge doubles every 3 years. It is said in medical education, “the more you know, the more you can know” and the truth in this statement is behind this explosion in knowledge. Simply, we know so much more about the cause of diseases and aging-the onset of multiple disease processes. We have developed fantastic diagnostic and testing tools that can detect illnesses in their earliest stages. Yet, our modern day health insurance industry is still geared toward heavy expenditures on the already ill and dieing. The average American has not been given the advantages our explosion in knowledge can provide.
Let’s not blame the insurance industry, politicians, and economists for all of this. We need to look at the attitude of the “average Joe” in America. We need to look at the American creed of hard and fast living. “I’m gonna die somehow, I might as well live it up”, “Something’s gonna get you”, “You only go around once in life”, “You are gonna go when the Good Lord calls you”, and others are fairly commonly heard in America- especially when the health risks of excessive tobacco, alcohol, and dangerous behaviors are brought up. What would be the benefit if the “Joe” watched his weight, exercised regularly, avoided tobacco, and partook of alcohol moderately? It is suggested that a 20 to 50 percent drop in health care costs would occur. What’s gonna change “Joe’s” mind-set?
Lo and behold, its already happening! Its become popular to be a “health nut”.
Vitamins and nutraceuticals are definitely “in”, even if you’re not exactly sure why and what you’re to take or what a nutraceutical is. Yoga, organic foods, and Day Spas with massage have become mainstays. If you’ve been in a position to afford and have had access, you have experienced a whole body scan or at least an ultra-fast Cat scan of your coronary vessels. These tests, and other advanced screening tests, are going to catch coronary artery disease, cancers, and various other diseases early enough to significantly increase your chance of surviving or limiting damage to your vitality. If you’re a doctor, a millionaire, or a movie star you might be a patient at one of the Longevity centers around the country, where you’ll be placed on growth hormone and other hormone replacements that holds the promise of keeping your body in a repair and rebuild mode past the age of 40, when multiple hormone levels decline. Americans are looking for better health and the alternative medicine industry is taking it to the bank in the tune of 60 to 100 billion per year. Chiropractors, herbalists, naturopaths, healing touch therapists, nutritionists, massage therapists, and others are stepping in to the role of pro-active health counselors that the fields of Family Medicine and Internal Medicine had seen as their role. They however, are too busy, to rushed, and to harried as they struggle against Managed Care’s onslaught on their incomes. They have been driven over the last 10 to 15 years to see more patients- faster. There is not enough time for delivery of effective, comprehensive, primary preventive medicine programs for their patients. This is a generalization, as many physicians are disgusted with their plight and reacted with the recent phenomena of the start-up of the “Concierge” medical clinic movement, where primary care physicians cut their patient list by 80 or 90% and charge a $ 4,000 to $6,000 premium per year to the 10 to 20% of patients who can afford it in order to provide them extraordinary care, quick service, and very much the “white glove” treatment.
Joe is not interested. Yet, his employer is getting ready to either drop his health insurance coverage or pass on a much increased proportion of the charges to him. Joe is working 15 hours overtime a week and just making it paycheck to paycheck. He doesn’t have money or time or energy to join the gym, get regular physicals, eat properly, get to his chiropractor, or visit the vitamin store. He’s mostly unaware that he’s headed toward a life of suffering from poor health and vitality past age 50. He’ll develop our society’s number one precursor illness to the major killers of cardiovascular disease and diabetes-metabolic syndrome. Joe develops this condition due to his high glycemic (carbohydrate) diet and lack of regular exercise. He receives his life-robbing diagnoses of diabetes at 52 and gets a new friend in the way of a highly talented local cardiologist who saves his life with placement of a stent in his heart at age 54. He’ll have sexual dysfunction due to vascular disease caused by the added stress of smoking 32 years. He’ll have arthritic knees due to carrying 50 lbs excess weight and medical disability at age 60 due to a combination of degenerative diseases. Joe will have to give up what had been a budding machine shop business that was to provide post-retirement income due to his failing health. What’s gonna turn things around for Joe and all of America’s workers? Doesn’t it make sense that if Joe is healthy then America will be stronger? What does a worker who continues maximal and increasing productivity mean to our economy? What does millions of post-retirement vital small business startups mean? What would it mean if Joe’s company’s expenditures on his health care could have been held low and the money gone toward a retirement program instead? Again, what’s gonna change Joe and his employer’s mindset?
Evidently, market forces are strongly in play. Approximately 5 % of Fortune 500 companies have chosen to move toward health insurance plans that cover catastrophic health conditions, where only tertiary preventive medicine steps such as coronary bypass surgery, cancer chemotherapy, dialyses, and trauma surgery are covered. They take the savings in insurance premiums and assist employees in taking advantage of Medical Savings Accounts where dollars placed in have certain tax advantages. An employee is placed in a position of being responsible for his health care expenditures. He will pay for the care he chooses out of that account. Theoretically, the employee would be motivated to work towards maximal health, utilizing the most effective and economical primary preventive health measures- so that he avoids disease development that would cause heavy outlays down the road for secondary and tertiary treatments.
It is a further developed and expanded Catastrophic Health/Medical Savings account approach that provides the opportunity to save the day for America:
What if Joe is provided the option of such a program when he first starts in the work force? What if Joe is given preventive medicine education in a successful model and encouraged to participate by his employer? What if laws are passed that provides true incentive in the way of a sheltered medical savings account where a portion of the investment-earned funds can be utilized later in life, flexibly, for such items as children’s schooling, retirement, home purchase, purchase of long-term care or life insurance? What if Joe and his employer’s rates go lower based on incentives for proof of good health practices such as abstinence from tobacco and maintenance of ideal body weight? Or, more radically, what if Joe had signed a contract that stated he could lose the privilege of participating in such a program or even loss of his job if random monitoring for nicotine presence, cholesterol profile, body fat percentage, muscle mass, aerobic fitness, nutritional status, etc. detected his failure to participate?
What would the influx into investment streams formed from Joe’s money do for our nation’s economy?
What if Joe missed less work due to improved health? What would the improved productivity do for us?
What if Joe increased his productivity 10% based on improved vitality good preventive health practices can provide?
What the benefit in productivity and worker’s comp savings for employers if Joe’s ideal body weight, aerobic fitness, and exercised-toned muscles prevented 50 percent of back strain and disc injuries?
How beneficial an impact to our economy can be reducing Joe’s likelihood of calling for social security disability prior to retirement age by 50% or more?
What do we stand to gain from our a much greater majority of our citizens having built a retirement income and not depending on Social Security retirement alone; or for that fact, what do we gain if 30 % more retirees are in a financial position to defer social security income to significantly later years for certain investment and tax incentives?
How great a benefit to our country if those qualifying for Medicare insurance at age 65 are 10 to 15 years less aged biologically than the health status of current new benefit recipients?
How much lessening of social ills would be gained by our country fully espousing aggressive preventive medicine that would start when Joe was just a baby? Would affording Joe the benefit of our explosion in knowledge in relation to nutrition and disease and accident prevention lower his chance of disability from mental illness? Would premature development of disability from obesity, type 2 diabetes, or musculoskeletal injury and compromise be avoided for Joe? Would there be less Joe’s committing crimes and spending time in detention if they grew up with a pro-active preventive medicine program in their lives?
When we consider these multiple potential benefits, we see the truth behind the assertion “Preventive Medicine Can Save America”.