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Perverse Outcomes: Part 1: Why Do We Have So Many Perverse Outcomes Between Commerce and Our Health?

Stanley Feld M.D., FACP, MACE

We are a very innovative people. As technology increases there are increases in goods and services created. Many of these new goods and services have been discovered to have unintentional negative consequences to our health. This is discovered after the product or processing of the product has been well established. It is difficult to reverse the exposure to these consequences without having grave economic and political consequences. Powerful vested interests exert political influence on policy to protect their profit domain at the expense of our general well being. This results in perverse outcomes.

We all know the healthcare system is broken. We are experiencing uncontrolled and unaffordable costs as our population becomes more obese and subsequently sicker. I have pointed out that the patients as the primary stakeholders are the most important members of the healthcare team. Physicians are also primary stakeholders. Their job is to teach patients to be professors of their disease in order to effectively prevent complications of chronic disease from occurring. The facilitator stakeholders are the government, the employers, the insurance companies and the hospitals. Facilitator stakeholders waste at least $150 billion dollars of healthcare costs a year through administrative waste.

Malpractice insurance and the threat of law suits because of weak government legislation, a topic I have not discussed yet, drives physicians to practice defensive medicine in order to avoid law suits. The cost of defensive medicine is beyond estimate. I would bet it is more than $150 billion dollars per year.

We also know that the complications’ of chronic disease consume 90% of the direct medical care costs of the health care dollar. If we can eliminate 50% of the complications, we could cut the healthcare bill theoretically in half. If this could be accomplished we could make health insurance affordable to everyone.

Obesity precipitates type 2 diabetes mellitus. The cost to the healthcare system is $160 billion dollars per year. The farm bill costs 25 billion per year in subsidies in order to help us become obese. This perverse outcome is the result of supporting the vested interests of the mega farmer and not the small farmer. Recently the cost of a bushel of corn has doubled because we do not have enough corn for food, animal feed and biodegradable fuel production. A complaint is there are too many ethanol refineries being built to make fuel from corn. The goal of the production of increasing amounts of ethanol for fuel is to free us from our dependence on foreign oil as well as create a renewable source of energy. However, this will result in a shortage for the food industry.

A simple solution is for congress to enact a law requiring all automobile manufacturers to produce ethanol friendly engines immediately. In addition, immediately enact a law that would permit the mega farmers to produce genetically engineered big corn. This corn would eliminate the shortage of raw material for ethanol, and lower the price of corn. The third immediately enacted law should be to eliminate corn subsidies. Finally we should eliminate corn and its many byproducts from the food supply. We would be on the way to eliminate manufactured food with excess calories which leads to obesity and diabetes. We could potentially save the healthcare system 160 billion dollars as well as eliminate our dependence on foreign oil.

This could be also being accomplished without government regulation by people buying only ethanol friendly cars and eliminating the purchase of junk food. It will probably be a combination of both.

We could do the same with soy bean production. These two sources of energy would be renewable forever. Tomorrow’s world will not look anything like todays if we had the leadership and courage to act.

If we built “clean” coal plants we would have a one time cost to build these 11 plants in Texas of $4.8 billion dollars. “Dirty” coal plants cause diseases that cost the healthcare system at least $34 billion dollars per year. The $34 billion dollars does not include the cost of care for autism. The autism and attention deficit syndrome cost has been estimated to be $100 billion dollars per year. How can we be so silly as to let this perverse outcome occur? We can announce that the people of Texas have stopped the building of dirty coal plants for the time being.

Osteoporosis complications cost 18 billion dollars per year. The cost savings of discouraging bone densitometry to prevent the complications of osteoporosis is insignificant compared to the cost of the complications of a disease that could be slowed or prevented. Why do we do this? We do this because some bureaucrat thought it was a good idea. It is a terrible idea.

The people must be proactive. We can turn most anything around. After many years people have pleaded for environmental responsibility because it is bad for our health and can have devastating consequences for our cities and ecological environment. All of a sudden are the last couple of months “Green” is in. We do not have Red States or Blue States because it is a bipartisan problem. We should have 50 Green States. We have to do everything we can to preserve our nations health, natural resources, and ecology.

Maybe the tipping point was Al Gore film “Inconvenient Truth”. Maybe the tipping point was Thomas Friedman’s series of articles on the importance of the environment. Even Newt Gingrich has stepped up to the plate and pleaded to not let the Democratic Party take over this important initiative because it is a problem all of us need to address. Mostly, I believe the tipping point was the education of the people. The popular sentiment of the people realized the common sense thing to do is to protect the environment for the good of the nation. The people, through public opinion, have pressured the congress and the various state legislatures to act. Now, policy is beginning to change. I believe policy can change and we will avoid perverse outcomes. We have the power to make it change. Instant communication through the internet will provide the education to force change.

I have pointed out several perverse outcomes that are harmful to the cost to the healthcare system. I will point out others from time to time in the series entitled “Perverse Outcomes.”

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