The Disconnect Between the Healthcare Debate and What We Know About Prevention

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In what seems to be a never ending debate on national health care, there is one fact that both the left and the right agree on: Americans spend the majority of our dollars on end-of-life crisis care and very little on prevention.

In this morning’s Washington Post, Fareed Zakaria argues that the free market – of which he is a big champion – mis-serves us when it comes to health care. He draws on the work of Nobel-prize winning economist Kenneth Arrow, who said that market forces fail in the area of health care because of “a huge mismatch of power and information between the buyer and the seller.” You can easily walk away from a car salesman’s pitch and buy another kind of car, for example, or choose simply not to buy a consumer good like a hairbrush. But if a doctor insists that you need a procedure or medication, you are unlikely to reject the advice.

My point here is not to advocate for national healthcare (though I’m not entirely sure it is a bad idea), but rather to provide context for and drill into my earlier statement. In this country, it has been hard to make a shift from pouring calories into extending the last few months of life to instead better using our earlier years well to build a long life free of diabetes and heart disease.

As the head of a food bank, I daily witness the power of food – not just to fill a stomach, but to over time tackle the troika of diet related disease that plagues the low income community: diabetes, heart disease, and obesity. Eating better and smarter is both an obvious and inexpensive means to prevent these diseases. And yet I have marveled that there isn’t more interest among hospitals and other health providers in partnering with us to do this preventative work. In this vein, Zakaria noted something that struck me anew:

“The problem with the free market is that there is little profit in prevention and lots in crisis care,” he wrote.

That may explain why the Capital Area Food Bank, which is providing food to 12 percent of the Washington metro area’s population and doing so in a way that boosts health and gives people knowledge about how to use food against diabetes and heart disease, has had no fewer than three dozen conversations with medical leaders that have all started off as promising but ultimately fizzled out. Health care providers know we need to do more prevention, but the lack of evident short-term profit may be the road block. This apparent myopia undercuts progress, as embracing longer term solutions like better eating habits will bring down not only the prevalence but also the cost of treatment of these diseases.

That’s one of the reasons that we are hosting a health care summit on May 18, bringing medical professionals together for a half-day session to discuss the powerful link between food and the two most expensive diet related diseases – diabetes and heart disease – and how to break down barriers so that we can do some of the obvious and necessary preventative work for low income communities.

One of these days, more people will see that the tools to slow the rate of onset of diet-related disease, both for the low income community and for wider society, have been right in front of us. We know what to do. We know how to do it. We just have to get serious about recognizing food as the best medicine, and in providing sustainable access to it.