For example, it is amply clear that at least 50% (if not higher) of chronic heart disease is caused as a diabetic complication. In fact, having type 2 diabetes is considered an equal to having had a heart attack! Similar relationships can be made to chronic kidney disease (dialysis), strokes, blindness, etc. Simple economic calculations of what a particular disease costs is a very incomplete method of assessment. It does not calculate the workplace inefficiency caused by chronic diseases, the cost of care-givers (family, nursing aids, etc.) not to mention illnesses that care-givers have due to caring for people with severe chronic illneses. Our daily observations are that those folks who drive up to our office in expensive cars, smoking 2 packs of cigarrettes a day with a Starbucks coffee in their hand are not infrequently those who complain that they cannot afford their medications! I wonder where our society’s priorities lie – may be Mr. Obama has a plan to help such folks. Quite frequently, we sit down with our patients and calculate for them the potential savings just by quitting smoking, that they could possibly use to get their meds. I suppose, that would mean that we’re supporting drug companies’ profits, in the language of the Democrats…

In my opinion, potential economic savings projected by Mr. Huckabee based on his assumptions may actually be the tip of the proverbial iceberg, the true worth of which may never be able to be quantified in conventional terms as elicited by this author. Why not make it an integral part of a larger strategy? Why shoot a very workable strategy down without even trying?

Now I have additional recommendations for Mr. Huckabee:

Aside from re-reading the Bible to come up with a solution to the health care crisis, it would be useful for him to read a recent commentary in the New England Journal of Medicine (http://content.nejm.org/cgi/content/full/358/6/549).

It explains in very simple terms why the American health care system (assuming that we have one) is so broken: “it is the price, stupid”, as economist Uwe Reinhardt wrote a few years ago. And we pay such exorbitant prices because of our reliance on private insurers who need a fragmented system to enroll the healthier and dump costly patients on the public sector (i.e. taxpayers), who do NOT need that the purchasing power of “consumers” be put together to regulate them, or, god forbid, get rid of them altogether (such as a single-payer system would do), and who DO need to sell garbage policies (i.e. high deductibles, co-pays and co-insurers) not because of the alleged risk that we will all rush to get a liver transplant if it is offered for “free”, but because they keep their business costs low by figuring out creative ways to not pay for our medical care.

My second recommendation is that Mr. Huckabee read a recent article in PLOS Medicine, performed by Dutch researchers (http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050029)

Their study showed that, while encouraging healthy lifestyles (e.g. telling people to eat their veggies, do their exercise, and not smoke) may be good for people because they will be healthier and feel better, it does not follow that it is a good strategy to control the costs of health care.

In fact, quite the contrary seems to be true: healthier people tend to live longer, and on the whole, end up by spending more. The “cheapest” patients are smokers, who get lung cancer and do not survive much. And probably the cheapest of all is to let people die. But of course with our current system (and most likely with many of the current reforms) this is precisely what we do: we allow some 18,000 thousand die every year by making it impossible to get perfectly standard medical care (Institute of Medicine, 2003).

So my two cents: if controlling costs for “the system”, whatever that is, is the goal, we could do so by by making health care so expensive that not even Health Affairs bloggers will afford to see a doctor.

But if what we want as a people is to make health care affordable so that everybody gets their share, because we want a healthy and happy population that is truly proud to be American, then we might have to deviate from Huckabee’s idiosyncratic “solution” to the health care crisis, stop trying to reinvent the wheel, and look for answers elsewhere.

However, as someone who is obese and has struggled through more than one lifestyle and fitness management program, I have learned that compulsive overeating is not easy to defeat. He was able to, but many other people try and fail – repeatedly. There may be profound emotional and in some ways spiritual aspects related to an addictive disorder like compulsive overeating. It is important that we do not further complicate a problem such as obesity
by proposing a simple solutions like economic incentives and social stigmatization. More effective disease management programs, better use of social networking technologies for social support, more effective medications that suppress appetite or moderate fat metabolism, and more insurance coveragfe for bariatric surgery might be more effective in the long run.