Erik Goldman12.01.08
Reframing the Healthcare Question
It is time to get the prevention conversation started.
By Erik Goldman
So, Barack Obama will be the next president. I’m very happy about this. I believe President-elect Obama is a highly intelligent, reflective and compassionate man who has a unique ability to tap into and inspire those similar qualities in other people—particularly those who’ve been disenfranchised from American politics.
In the difficult straits ahead, intelligence, compassion, vision, pragmatism and cool-headedness can only be assets. Obama has shown all of these. In short, I like a whole lot about Barack Obama.
Unfortunately, I don’t like his healthcare plan. And honestly, I wouldn’t have liked John McCain’s any better. Why? Because in both cases these reform plans are based on the wrong premise—they’re asking the wrong questions.
The entire public dialogue about healthcare—a vast and complex set of subjects—has been hacked down to a single, almost mindless question: how do we increase the number of people who have health insurance? Democrats and Republicans differ substantially on how they would finance an answer to that question. But there seems to be strong bipartisan agreement that this is the main objective.
I think we need to reframe the entire question. We need to crack that seemingly ironclad (though questionable) premise that having health insurance is synonymous with having healthcare. And we need to ask ourselves what healthcare really is, and what it could or should be.
What kind of healthcare do the insurers currently provide and are we OK with that? Is this all people need? What sorts of systems would empower—not coerce, but empower—people to live in healthier ways? What policy changes would have the greatest impact on preventing the huge burden of diseases that we know are fueled by unhealthy lifestyle, poor diet and environmental toxins?
Once we answer these questions, then—and only then—can we reasonably talk about how to finance a reformed system. Otherwise, we’re simply arguing over how to fund more of what we’ve had. And judging from what I hear when people talk about their health insurance plans, that’s none too good.
Dr. Roby Mitchell, a holistic medical doctor in Tahoma, WA, is fond of saying, “You’ll never medicate (or, “supplement” if you wish) your way out of diseases you behaved your way into.” Extending this axiom, we could say that we’re never going to finance our way out of epidemics we’ve eaten and lifestyled our way into.
Is healthcare reform likely in a first Obama term? It’s hard to say. Other issues like taxes, foreclosures, Wall Street rescues, plumbers, vice presidential clothing allowances and the ghost of 1960s radical activism certainly eclipsed healthcare on the campaign trail.
But the issue is not going away, and President-elect Obama has repeatedly stated that universal healthcare coverage is a fundamental goal of his administration. Rahm Emmanuel, Obama’s new Chief of Staff, comes from a medical family and healthcare is one of his pet issues, so we’re likely to hear a lot more healthcare rhetoric in the coming months. But Emmanuel is also a political centrist, who was in the thick of the Clintons’ healthcare boondoggle in the 1990s. He has cautioned Democrats against attempting another large-scale Clinton-esque overhaul.
Of course Hillary Clinton is still in the Senate (unless Obama taps her for Secretary of State), as is Edward Kennedy, and there are plenty of other major healthcare reformers inside the Beltway, who will likely push Team Obama to make good on their promise of universal coverage.
Realistically, I think economic stimulation and foreign policy challenges will take center stage, at least for the first year or two of the Obama presidency. So while there will be talk about healthcare, I don’t think we’ll see much actual movement.
And that, to my mind, is a good thing. It will give us the time we need to really think this through, to ask the complicated questions we’ve been avoiding, to re-define what healthcare ought to be, and to look seriously at how to finance it. Just shoving millions more people into existing insurance plans won’t really change the system for the better.
The Obama presidency, with its mandate for change (however tempered that may become once he takes office), and its surge of fresh civic vigor (however challenged by economic woes it may be), represents a singular, once-in-a-lifetime opportunity to open up a real discourse about healthcare in our country. That window won’t remain open forever. The question is, will we seize the moment?
I sincerely hope that those of us who are serious about holistic healthcare, nutrition and natural medicine will be part of that conversation; that we will step up and show the new leadership what this movement, this lifestyle really has to offer; that we will lead an effort to craft healthcare policy that supports preventive medicine rather than simply funding more disease care; that we will work constructively with legislators to create a better regulatory infrastructure that safeguards individual health choices, while at the same time safeguarding individuals from predatory businesses and poor quality products.
I urge the organizations representing the natural products industry and the various holistic medical professions to come together, to hash out a broad but clear agenda for true health-centered reform, and then to do whatever is possible to get that in front of President Obama, congressional health policy makers and allies in the business world who are clamoring for the very sort of proactive, consumer-centered healthcare that our movement has always supported.
It can’t just be about DSHEA and GMPs and company self-interest. We need to think big. Really big. We’re part of healthcare. I believe we’re a vital part of healthcare, an essential factor for a healthier future.
Mr. Obama himself seems to be a role model of good health—he eats right, exercises regularly, and does his best to nurture love and warmth within his family—even amid the insanity of a highly public life. If we can develop a solid agenda for health-centered, prevention oriented healthcare, I believe Mr. Obama will at least take a serious look.
Of course, we also have to keep ourselves and our businesses afloat in these recessionary times. And that’s going to be a challenge.
Word in the aisles at the recent Natural Products Expo East show was that “our industry has always been pretty recession-proof.” But people were saying it more like a prayer than a confident assertion. This is no ordinary recession, and everyone knows it. Most of the company heads I spoke to said that so far their sales haven’t been hit too hard, but few are resting easy.
Greg Badishkadian, an analyst for CitiGroup, who tracks the natural products/healthy lifestyle industry, said in his post-Expo teleconference that overall the industry remains pretty strong, with an annual growth rate of 8-10%. But that’s largely driven by food. As people feel the economic pinch, they eat out less, and cook at home more. They’re demanding healthier products, hence the continued growth of the healthy food sector. This phenomenon was easily observed at Expo itself; most of the floor action was in the food sections; the supplements aisles were far less crowded.
Mr. Badishkadian said he remains bullish about the industry overall. On the supplement side, he sees a relatively bright future for probiotics, “energy” products, and products based on “superfruits” and “superseeds,” such as acai, goji, maca, chia and Salba. But with consumer spending in a tailspin, widening unemployment, more foreclosures and loss of personal wealth, he predicted choppy waters ahead.
The seeming resilience of the industry so far may be due to the fact that the economic crisis has yet to really bite the relatively affluent socioeconomic strata. The people who’ve been hit hardest—the marginally middle class, the manual labor sectors, the already poor—have not historically been the core demographic for the natural products industry. When the white collar crowd (that’s us, folks)—business people, media professionals, educators, healthcare practitioners, lawyers—start losing our jobs, well, we’ll see how resilient the industry really is.
Mr. Badishkadian said that there’s no question it will be harder for smaller companies to survive. Credit and venture capital are already hard to obtain, and that will only get harder if the crisis deepens. “We expect to see more bankruptcies in the next 12-18 months.”
Bankruptcies, and buyouts. But the buyouts won’t carry the bodacious financial rewards they once did. “Owners of private companies remember the valuations of 12-18 months ago. But things have changed,” Mr. Badishkadian said. “Big companies have less appetite for acquisitions now.”
In the healthcare practitioner channel, we saw two very significant merger/acquisitions this fall: Nature’s Way’s acquisition of Integrative Therapeutics (the umbrella company for Enzymatic Therapy); and Country Life’s acquisition of Allergy Research Group (Nature’s Way is owned by Schwabe Pharmaceuticals in Germany; Country Life is owned by Kikkoman, the Japanese soy sauce giant). The little birds tell me that other very significant deals involving major practitioner-channel players are in the offing. No doubt similar things are happening on the consumer products side.
Whether the shakeout and consolidation process ultimately strengthens the industry or co-opts it remains to be seen (it may do both!). But the challenge of improving the health of our nation will remain as pressing as it’s ever been. I do believe we’re at a very unique interval right now. As individuals and as an industry, we need to get involved in taking up that challenge.NW
Holistic Primary Care’s first conference, called “Heal Thy Practice: Transforming Primary Care” at the Westin La Paloma in Tucson, AZ, has been re-scheduled for June 5-7, 2009. The conference will explore viable business models that support and sustain the practice of holistic medicine. For more information about Holistic Primary Care or the “Heal Thy Practice” conference, visit www.holisticprimarycare.net or e-mail Erik@holisticprimarycare.net.