Monday, March 26, 2012

Go to Health – Health Insurance for Everyone

T.R. Reid wrote a brilliant book in 2010 – The Healing of America – A global quest for better, cheaper and fairer health care. He examined industrial democracies around the world and explained their different yet effective health care systems. By a variety of means, they achieve nearly universal coverage and good outcomes. If you don’t have time right now to read a book – albeit an entertaining one –as the health care debate is being discussed in the Supreme Court, here’s a short cut. Fareed Zakaria has written a two page article in the March 26th issue of Time that summarizes many of the issues. The requirement that everyone buy health insurance – called the individual mandate – is at the center of the constitutional controversy. Government subsidies would be given to help those without sufficient funds to buy insurance.

Reid and Zakaria both point out that Switzerland, a business-friendly democracy, had a system like ours 20 years ago, with private insurance and incomplete coverage. People without insurance went to emergency rooms, insurers rejected people with pre-existing conditions, and costs were mounting. The country decided that to make health care work, everyone had to buy insurance. They reformed their system in a way similar to Obama’s proposals. Now, 20 years later, everyone is insured, the quality of care is high, and costs have moderated. I can attest to this, as I visit my sister in Switzerland every year, and have seen her in the hospital there. The care is excellent. Taiwan is another with a free-market economy that decided to create a universal health-care system in the mid 1990’s. It studied all existing models and decided against private insurers, and for a single payer system that is effective and very low cost. ”. The Swiss and Taiwanese found that it is imperative for everyone to be covered by health insurance to keep costs down and provide a system where everyone has basic care.

Reid writes that the Swiss have an ethic of ‘solidarity’ that helps maintain their unity despite having 4 official languages. Solidarity means community and equal treatment. Everyone should have equal access to vote, have a jury trial, an old age pension, a good school system and a good health care system. Some people have much more money than others in their capitalist system of government, but everyone has their basic needs for health care met.

Zakaria writes that we have “the most expensive, least efficient system of any rich country on the planet.” Chronically ill patients , 5% of the population, account for 50% of our health care costs. Their care drives up insurance premiums if they are insured, and federal, state and local health care costs if they lack insurance. Universal coverage would bring healthy people into the system and thereby result in lower average premiums. A downside to Obama’s plan is that it maintains the connection between employment and health care that is inefficient and a burden on American business. It is hard for companies to be competitive globally when they are paying large amounts for their employees and former employees. German, Canadian, Japanese and British companies pay next to nothing in health care costs, in comparison.

I hope our country can edge away from rugged individualism into more solidarity, with passage of universal health care. Stay tuned throughout the week as it is debated at the Supreme Court. E pluribus unum.
Sadja Greenwood, MD, MPH - back issues on the blog

Thursday, March 8, 2012

Volumetrics - a plan to reach the right weight and stay healthy

Here’s an interesting finding – as long as food is equally palatable, people tend to eat the same weight of food. The March issue of the Nutrition Action Health Letter features an interview with Dr. Barbara Rolls, at Penn State University, who has been studying this for years with the aim of helping people lose weight more easily. Her latest book – The Ultimate Volumetrics Diet – will be out in April; previous books include The Volumetrics Eating Plan. She has looked at ways to change the amount of water in foods, thereby adding weight and volume but no calories. This is done by adding vegetables to each recipe, and making sure the food is tasty. The result, found in careful studies, was that people reduced their calorie intake by about 25%. In a trial of 700 people, she found that when people ate a diet that was less calorie dense (more vegetables included) they were eating significantly more food – about a pound more food a day – yet they were eating fewer calories and easily losing more weight. In another study, people who successfully lost 10% of their maximum body weight and maintained the weight loss for at least five years were found to eat five servings of vegetables a day. Overweight participants ate three and a half servings. Besides adding more vegetables to recipes, calories are cut by reducing fat and sugar in sauces, using small amounts of olive oil instead of cream, switching to whole grain pasta or brown rice, and removing fat and skin from poultry or meat. Dr. Rolls advises adding vegetables to mixed dishes, soups and stews, and putting cooked vegetables in a blender for sauces. She suggests adding vegetables to breakfast, lunch and dinner for children and adults. She found that baked goods with added vegetables – such as extra carrots in a carrot cake – made the cake even more palatable, so people ate more. However, at the end of the day they had consumed fewer calories.

Studies done on portion size were also important – Dr. Rolls found that while people tend to eat the same weight of food day after day, when exposed to large portions they get thrown off very easily. Portion control is still important for all eaters, and it starts with visual awareness. Some people use a 10 inch rather than a 12 inch plate at home and automatically eat less. Some divide a restaurant entrĂ©e in half, and share the food or take half home for the next day. Some ask for a child’s plate, which is easy if you are ordering takeout. People interested in portion control avoid buffets and all-you-can-eat restaurants, or exercise great care therein.

Mindful eating is another important way to slow down and appreciate food. Become more aware of your hunger before eating and feelings of fullness as the meal goes on. It can take 15-20 minutes for the brain to register that you have had enough, so overeating is easy when you are rushed. Some people set a timer for 20 minutes and make sure they savor their food while making it last until the bell chimes. Eating while reading or watching television can lead to mindless stuffing for some people. Become aware of gratitude for the food you have, for the animals who gave their eggs, milk or life, and for the people who harvested and prepared food for your table. Be aware of your personal triggers for mindless eating, such as anxiety, depression, alcohol, marijuana or certain chips and sweets.

For anyone who wants to keep up on the science of healthy eating, subscribing to Nutrition Action Health Letter is a great idea. Go to
Sadja Greenwood MD, MPH back issues on this blog