Making America Healthy Again: The Gravity of Our Current Situation

Before we can start the work of Making America Healthy Again, it is important that every American understands the gravity of our current situation as spelled out in a great article from the Wall Street Journal. Understanding our baseline is critical because the changes required to Make America Healthy Again must be so extensive.

The very high costs of our healthcare system are breaking budgets at every level and and the outcomes are so poor that our mothers, sisters, friends, and neighbors are dying or becoming disabled at a rate much higher than in other developed countries. We spend on dollar out of five on healthcare. That is twice as much as other developed countries and it increases the deficit. It pulls money from other pressing needs like infrastructure, defense, and education. It is a national security issue. I hope you will read the article from the Wall Street Journal yourself. That is a conservative business newspaper. It is no product of the radical liberal left and the article is sobering.

It is important for you to understand this information precisely because the stakes are so high and the extent of change required to fix it is so great. Every time we start discussing real healthcare reform that matters to you, the current special interests that are pulling every dollar they can out of our governments, employers, and your family push back hard. They start running around like their hair is on fire. When we start discussing drug price negotiation, the drug companies run emotional ads claiming you won’t be able to get your drugs or they won’t be able to develop the next cures. It is all a distraction. It is a barrier to Making America Healthy Again. Every other developed country negotiates drug price and they pay $93 dollars a month for Ozempic. We pay $1000. That is a huge barrier to Making America Healthy Again.

The Wall Street Journal article lists the common chronic disease that affect many people. Almost half of American adults have high blood pressure. Forty percent are obese. Nearly fifteen percent are diabetic and about thirteen percent have chronic kidney disease. These conditions are all related in their root causes and in their management. High blood pressure, obesity, diabetes, and chronic kidney disease are super priority chronic conditions because they are so common and so impactful. A single independent outpatient advanced primary care team can address all these conditions concurrently. High triglycerides, high bad cholesterol, low good cholesterol, heart artery disease, other artery disease, and congestive heart failure are all related as well. Most people with chronic kidney disease have it because their high blood pressure, obesity, and diabetes was inadequately treated. These super priority conditions are all related. Because we have not adopted the new science and systems to manage these chronic conditions more effectively, Americans live shorter and less healthy lives than people in other high-income countries. We eat much more highly processed and fast food than other developed countries. The failure of our healthcare system to adapt to these new realities contributes as well.

We don’t live as long as people in other advanced countries because of more deaths in working age adults. In 2021, 250 out of 100,000 adults aged 50-69 died of cardiovascular disease in the United States. An average of 100 out of 100,000 adults in that age group died in other countries due to those same causes. Your chance of dying from cardiovascular disease before the age of 70 is two and a half times as high if you live in the US even though we spend twice as much on healthcare. We are all in the same healthcare system and our system is not designed to keep you healthy. It is designed to rescue you late in the disease process. Everyone in the building from the janitor to the CEO is at risk.

These countries with lower cardiovascular deaths have a healthcare system that is rooted in outpatient primary care. We spend 20% of gross domestic product on healthcare. Singapore spend 5%. Singapore has a system based in primary care. This nation of 5 million people has 20 one-stop outpatient primary care clinics that have teams that are focused on treating the super priority conditions hypertension, diabetes, and high cholesterol. That is one reason why their healthcare costs one forth as much and half as many die of cardiovascular disease. Every person in other countries also has access to care. No one is left without health insurance. No is left without inexpensive care for hypertension, obesity, diabetes, and so they are much less likely to develop chronic kidney disease. The annual cost for a patient on dialysis in Medicare was $100,000 in 2021). These figures primarily represent Medicare's paid costs. Commercial insurance plans consistently pay much more for dialysis services than Medicare. Studies have shown that private insurers might spend $100,000 to even over $300,000 annually on all healthcare services for a person with end stage chronic chronic kidney disease on dialysis. That is the very definition of “penny wise and pound foolish.”

This current Wall Street Jounal article is featured in this series because It tells us where we should begin. Cardiovascular disease is the leading cause of death in our country. The first four common conditions listed are related. We know what causes them and they are the conditions for which best practice treatments are most clearly defined. They lead to other chronic conditions like heart attacks, strokes, heart failure and vascular dementia. They are the super priority conditions. This data and evidence is so clear that it would be highly unethical— it would be a massive failure of leadership —to fail to begin in earnest now — immediately— to bring the stakeholders together to begin the process.

We spend twice as much while twice as many people die in the prime of their life. This is entirely due to a failure of leadership. Leaders in other developed countries have worked this out and we have not Our current healthcare system dominated by large hospital systems and insurance companies that answer to stockholders does not work. They have proved they cannot give us a system that works for us. It is time to face reality and do something different.

We have identified the urgency of bringing the stakeholders together now and getting started now. Hundreds of Americans are dying, suffering, becoming disabled, and experiencing financial ruin because we know what we should do and we do nothing. We have identified the super priority diseases and the need for the stakeholders to convene urgently. Next we will go into more detail on the execution steps.