As I've said so often, we are actually having a “disease care” debate. As my article shows, the money is spent on hospitalizations and critical care—we only spend a tiny fraction on “health”. But there is indeed a crisis and it seems obvious that the potential harm from (1) doing nothing or (2) blindly implementing some of the wild ideas being floated are both enormous. In my article I discuss many of the factors, hopefully in a logical and non-partisan way. When Washington is left alone, too often decisions are influenced by special interests. Decide whatever you want but make your voice heard.

My aim is to keep this discussion non-political and non-emotional. It seems obvious that the potential harm from (1) doing nothing or (2) blindly implementing some of the ideas being floated are both enormous. I believe Washington needs to take a breath and think this situation through. Use some common sense and assure we know the long term impact of any changes. The list of issues below is not necessarily prioritized and certainly is not complete. But it is a start. The opinions are my own. At the end there is a way to let your feeling be known.

•  The government should use its power of policy making, rule enforcement and financial reimbursements to direct meaningful focus on REAL DISEASE PREVENTION. Currently most of the costs in medicine are expended on crisis management near the end of life. For example, diabetes leads to heart disease, kidney disease and amputations. The patient's life deteriorates and the care becomes extremely expensive. Healthy folks don't require the same heart bypass surgery, dialysis, surgeries, wheel chairs, etc. There is no question that gigantic improvements in the reduction of costs and suffering would come from preventing chronic disease and keeping folks out of the hospital. Remember that early detection of disease is not the same thing as preventing disease from even starting. To extend the previous example, that would mean helping people keep their blood sugar in the normal range—not intervening with medicine later after they are in the high blood sugar “pre-diabetes” stage. Below are a few specific areas where government can make a big difference by assuring that government rules and expenditures are aimed at prevention:

•  The US Department of Agriculture pays farmers to help them profit from the production of various crops. One of big ones is sugar. Those subsidies keep sugar very cheap so it appears in virtually all processed food and restaurant recipes. (In some years they even subsidize the farming of tobacco!) If we stop the subsidies: (1) we can use the money that we save for health promotion; (2) with sugar costing more, people will likely eat less of it; (3) the farmers will farm something that isn't subsidized – maybe vegetables?

•  The US Supplemental Nutrition Assistance Program (formerly known as Food Stamps) helps low income families buy food. I believe the rules about what families can buy with the government funds needs some work. In 2004, the State of Minnesota wisely asked the USDA to prohibit the purchase of candy and soft drinks with food stamp benefits. The USDA denied the request. For some reason it seems the stamps can't be used for warm foods. In what LaLa-land does it make sense that food stamps can buy a Pepsi ® or a Starbucks Doubleshot ® but not a ready-to-serve high protein rotisserie chicken? Or where a LifeSavers ® candy is okay, but a kid's multiple vitamin pill is not. For over a decade the USDA has been studying the idea of using the program to allow recipients to purchase vitamins and minerals. Now that we know, as just one example of hundreds, that vitamin D is crucial to preventing the flu (H1N1 perhaps) and many other diseases; it is high time to end that debate.

•  Federal funds provide commodities and supplements for school lunch programs. They have made some improvements but can do more to require the schools to serve healthier foods or give up the freebies.

•  Only 3% of the cost of healthcare is on “government public health activities”. How about more effort in that area to curb obesity and promote exercise? How about spending more at the NIH looking at non-toxic, non-invasive natural remedies?

•  We need more education at all levels about the importance of vegetables and the problems of excess intake of sugar and bad types of fat. Food labeling is getting better (e.g. Trans Fats are finally listed) but there is more the government can do. Information about calorie counts and suspect ingredients should be more readily available in chain restaurants.

•  Require the FDA to adopt a more open-minded attitude toward dietary supplements. Despite tens of thousands of studies showing benefits, so far the agency seems to only look for risks , not benefits . This leads to supplement scrutiny all out of proportion to that given to drugs. A few dozen people get sick each year on supplements (mostly due to abuse or confusion about the cause) but meanwhile hundreds of thousands die from drug effects . Often supplements can prevent and even treat conditions allowing consumers to avoid the risks of drugs.

•  Allow Medicare and Medicaid reimbursement for nutritional testing to see what people lack that they need to stay well.

•  Allow Medicare and Medicaid reimbursement for thermography—a type of breast cancer screening that does not use x-rays (radiation itself causes cancer.) Another example—currently the agencies will reimburse for the costs associated with hospitalizations and even surgery for diverticulitis, but not for the outpatient colon therapy that might get rid of the condition.

•  Tighten the requirements regarding toxins in the environment, foods and consumer products and thereby reduce the incidence of lung problems and cancer. I'd put excess use of antibiotics in agriculture (as well as medical treatment) in that category. When we look at the role of our beneficial bacteria , it makes absolutely no sense to kill them off unnecessarily. Fungus on grain crops should be another target because they act as antibiotics in our system.

•  Just as the government reduced use of tobacco and raised revenue with a “sin tax” on cigarettes, put a sin tax on soft drinks.

•  Legislators should listen very carefully to the wonderful and practical ideas from the expert panel of famous integrative medicine doctors that testified recently before the Senate Health, Education, Labor and Pensions Committee. Link to video .

•  We should cover everyone who wants insurance. It not only seems right morally but also because we already pay for the health care of the uninsured indirectly. They end up with last minute treatment in emergency rooms (risky and inefficient). Hospitals pass those costs on to those who are insured and the insurance companies pass on the costs to their customers. Incidentally, hospitals also must charge the rest of us more to make up for the lower fees they are paid by Medicare and Medicaid. There is no free lunch.

•  Insurance regulations need reform. It sounds like a very good idea to allow consumers to take their insurance with them when they leave a job (portability) and to prevent insurance companies from refusing insurance to those with pre-existing conditions as well as keep them from dropping people who get really sick. However, such changes have to be made thoughtfully because of those tricky “unintended consequences.” How could a health insurance company stay in business if too many people bought insurance after they get sick but drop it when they get well? How would they accumulate money to use to pay claims? (E.g. there is a reason we can't buy car insurance after the accident and drop it as soon as the car is repaired.) Why wouldn't the cost of health insurance come down if companies were allowed to compete across state lines? Now, for reasons I don't understand, they are forbidden to do so.

•  Allow Medicare to negotiate drug prices. The US Department of Veterans Affairs saves a lot of money doing this. Who has more buying power than Medicare? That would save a bunch of money and the only reason I can imagine that we aren't already doing this because of pressure from the special interests.

•  Implement torte reform—e.g. limit frivolous and hugely punitive lawsuits . Doctors often perform medically unneeded tests and procedures just to leave a big paper trail in case they are sued. Malpractice insurance also drives up costs dramatically. However, again, proceed with caution. In Texas , I believe the limits on awards for malpractice lawsuits were set too low. Now there is not sufficient incentive for good lawyers to go after really negligent docs, hospitals, nursing homes, etc.

•  Give more incentives for medical savings accounts. They give consumers more choices and surely participants are less likely to spend their own funds on unnecessary procedures.

•  Don't even think about funding cutbacks to Medicare as a way of paying for proposed changes . Medicare is already in deep financial trouble and will be bankrupt in 8-10 years. Cutting will have to mean reductions in services to seniors. That's because we've gone about as far as we can cutting reimbursements. The skimpiness of payments to medical professionals is driving thousands of doctors to ban Medicare patients. We need to remember that doctors are forbidden by law to make up their losses by charging other patients more than they charge their Medicare patients for the same service. So the top-rated doctors often just opt out of Medicare.

•  Don't fine businesses for not providing health insurance (theoretically a way of covering more people and generating funds). Having been a small business owner myself in the past I'm sensitive to the fact that such penalties might put a great many of them out of business. Small businesses create most jobs in the US and so that would mean loss of jobs. Some companies might find it would actually cost less to pay the fine than to provide the insurance. That could kick some people out of coverage they now enjoy.

•  Rethink having boards that decide what is good and cost-efficient care. Sure they would theoretically review research and recommend what works which sounds logical on the surface. Even if (and it's a big if) regulations didn't indirectly give them the power to also dictate what care was provided, at least so far the “experts” the government has chosen as advisors for anything are almost uniformly sympathetic to only pharmaceutical approaches to disease management. The panels would work with statistics and averages but I want to have the kind of treatment that recognizes my biochemical individuality and integrates nutrition and natural methods. Furthermore, in other countries that have government-guided care, whenever there isn't enough money to treat everyone, they start rationing to groups that can supposedly contribute less to society—e.g. the elderly and impaired. Hey, I'm a senior citizen and I've just figured out what I want to be when I grow up!

•  Don't increase the deficit. Non-partisan government analysis says that new efficiencies (e.g. electronic records) and reducing Medicare fraud will not pay for even a small part of the cost of most reform plans being discussed. Please, generate new revenue sources in a way that doesn't kill jobs and cut fat somewhere else but don't increase the US debt.

•  Forget adding a whole bunch of new agencies, layers of bureaucracy and tons of new federal employees . Not only do some of the proposed organizational charts look inefficient—they look very expensive! Doesn't the government already have 4 plans that manage health care? Surely there is a way to work within Medicare, Medicaid, the Veterans Administration and the Federal Employees Health Benefits Plan.

You can make a difference. Whatever your thoughts, call, visit, write, fax or email your legislators and tell them. Please be respectful and avoid wild accusations because that is when they stop listening.

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