SEATTLE--All of the government manipulations of the US health-care system will have little impact on the more potent forces--demographic, social, scientific, cultural, moral, and legal--that shape the American way of health and fuel its cost, says former Secretary of Health, Education, and Welfare Joseph A. Califano, Jr.
SEATTLE--All of the government manipulations of the US health-caresystem will have little impact on the more potent forces--demographic,social, scientific, cultural, moral, and legal--that shape theAmerican way of health and fuel its cost, says former Secretaryof Health, Education, and Welfare Joseph A. Califano, Jr.
Mr. Califano, who is currently president of the Center on Addictionand Substance Abuse (CASA) at Columbia University, is a strongbeliever in "radical surgery" for the way we approachhealth, life, and death in America.
This radical surgery cannot be accomplished through legislation,he believes, but rather through changes in our basic thinkingabout health and individual responsibility.
The lesson of 1994, when President Clinton's administration broughtforth its "preposterously bureaucratic" health careplan, he said, is that no single law can revamp the entire health-caresystem. Instead, he stressed, reform is a perpetual process, andachieving universal coverage is a long-term proposition.
Speaking at the presidential symposium held during the AmericanSociety of Hematology meeting, Mr. Califano described our currentsystem as providing "sick care" rather than "healthcare," ie, programs that foster healthy lifestyles.
Although he praised the accomplishments of America's researchcommunity, he looks with dismay on how new breakthroughs are sometimesperceived by consumers.
"We see them not as palliatives to be used when we becomesick despite our best efforts to stay healthy but, rather, asa means to allow further overindulgence, inactivity, and abuseof mind and body," he said. "If Moses were an Americanin the 1990s, the tablets he would bring down from the mountainwould be Prozac and aspirin, not a set of commandments to guideour conduct."
Mr. Califano believes we should target the root causes of illness--the"deadly pantheon" of tobacco, poor diet, sedentary habits,alcohol abuse, preventable infections, environmental hazards,risky sexual behavior, and illicit drug use.
He pointed out that we pay a price for our failure to invest researchand prevention dollars in efforts to encourage people, especiallyadolescents, to adapt healthy lifestyles.
"We now know that a youngster who makes it through thoseteen years, from age 10 to 20, without smoking cigarettes, abusingalcohol, or using drugs, is virtually certain never to do so forthe rest of his or her life," he said.
One area of health care that has not skyrocketed in cost, he noted,is dental care. Improvements have come less from "filling,pulling, and handling sick teeth and infected gums" thanfrom preventive efforts, such as fluoridation of water, improvedtoothpastes, flossing, and reduced sugar intake.
"Perhaps, most importantly, our society has made dental hygienechic. Whiter, healthier teeth are a prerequisite in America forbeauty in women and good looks in men," he said, adding that"we don't see that as health promotion and disease prevention,but that's exactly what it is, and it doesn't involve impositionof any government regulations."
In his ASH presentation (see story above), Joseph A. Califano,Jr., illustrated his contention that the American system doesa poor job of promoting health with a story about the "Calverts."
The mother, aged 55, died of natural causes but had long sufferedfrom arthritis, osteoporosis, and malnutrition. Her infant girlwas also malnourished and died from spinal meningitis. The fatherhad been sedentary and overweight, and died at age 50 from a heartattack.
What sets this American family apart is that they lived in thecolonial period, and a study of their remains in 1992 providedwhat researchers called "grim evidence of the harshness of17th century life."
Indeed, Mr. Califano pointed out, modern medicine could probablyhave added years to the parents' lives and rescued the child frommeningitis.
"But most of what ailed the Calverts, the arthritis, osteoporosis,malnutrition, and heart disease caused by excess weight and sedentarylifestyle, would probably still afflict them in the 1990s,"he said. "For in America, we have made far less progressin keeping people healthy and out of the sick-care system, thanin providing treatments once they become sick.