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Dr. Jen Gunter

Dr. Jennifer Gunter is a nationally and internationally renowned obstetrician/gynecologist.

April 19th, 2012 2:03 PM

If you believe in universal health care, take this challenge

The Affordable Care Act (ACA) has polarized many people (if you are among the minority that don’t believe me, check out the responses on my post Cancer v. The Constitution). While I am the first to admit the law isn’t perfect (for example, lack of accountability from insurers and providers regarding charges and cost of care), the legislation does contain many good things (e.g. health insurance for all, no pre-existing conditions, and no co-payment for vaccinations).

I believe an imperfect law that sets us on the right course (health care for all) is better than our current system. Let’s not forget the constitution wasn’t perfect at birth, hence all those amendments I learned about studying for my citizenship test. The fact that a piece of legislature might need some fine tuning down the road is not a new concept and is surely something we can handle.

As I thought more about the ACA and about accountability from insurers, Big Pharma, and providers, I also thought about personal accountability. If you support universal health care, then you must also believe that we are all stewards of the system and so it behooves each one of us to do our personal best with our health. First of all, we’ll be healthier (that’s the goal of not only the ACA, but really everyone’s goal, is it not?). And secondly, striving for better health as well as being responsible with health care lowers costs for everyone. Think of it as resource conserving, just like turning down the heat while you’re sleeping lowers your energy bill and reduces your carbon footprint.

So if you believe in universal health care, I challenge you to make 4 changes this year in your health. The kicker is you have to build on each change, so once you have done one thing, you have to keep it up while working on the next.

If you’re stuck for ideas, here are some suggestions:

  1. Walk 150 minutes a week (that’s 30 minutes 5 times a week). It has health benefits that equal a 20 lb weight loss. Start with 10 minutes a day at lunch – you’ll almost be 1/2 way there. If you are already exercising regularly, find a way to do just a little bit more.
  2. Eat breakfast (a healthy one, if possible) every day. It doesn’t matter if don’t think you’re hungry (although, you probably are and just don’t know it). Many of my patients complain of fatigue and almost always when I ask what they had for breakfast, the answer is, “Nothing.” Your body has fasted all night and needs energy for that 30 minute walk you have planned! And if you are trying to lose weight, well, studies tell us you will be more successful if you eat breakfast.
  3. Eat 25 g of fiber a day. You may think you eat a lot of fiber, but the average American diet has approximately 10 g. Check fiber content on food labels or online and keep a log for several days to keep yourself honest. A high fiber diet is associated with lower rates of obesity and makes you poop regularly. Hey, constipation accounts for 8 million doctor visits a year! In one study, Medi-Cal (California Medicaid) paid more than $18 million over 15 months for the diagnosis and management of constipation! Fastest way to 25 g a day is a high fiber cereal (remember breakfast!). My favorite breakfast is 1/3 c Bran Buds (13 g of fiber) with Greek yogurt and 2 tbsp. of walnuts.
  4. Be sexually responsible. Limit your sexual partners, don’t hook up, and make sure you have safe sex. STDs cost $17 billion a year, yet are essentially preventable. No torrid encounter in an elevator is worth gonorrhea, chlamydia, or HIV.
  5. Speaking of chlamydia, if you are a woman and 25 years or younger get tested every year for chlamydia. Chlamydia typically has no symptoms, but it can spread to the fallopian tubes causing a serious pelvic infection. Annual screening (and treatment if you are positive) dramatically reduces the risk of this pelvic infection. If you don’t have health insurance you should be able to get tested for free at your county health department, but college health departments and Planned Parenthood are also lower cost options. 
  6. If you smoke, quit now. Really, call 1-800-quit-now. Right now. Smoking causes asthma, emphysema, cancer, premature delivery, and if your baby is exposed to second hand smoke he is more likely to develop asthma or die from SIDS (sudden infant death syndrome). Nearly 1 in 5 deaths in the US is smoking related and we spend $96 million/year on direct medical costs related to smoking.
  7. If you are overweight or obese try journaling. Studies tell us people eat about 1,000 calories more a day than they think. Weighing and measuring portions and writing everything down is a cornerstone of weight loss. Try and lose 5-7% of your body weight, you will reduce your risk of getting diabetes and you will feel better.
  8. If you don’t want to get pregnant (or get someone pregnant) use contraception. Yes, it should be covered by every health plan, but make every effort to get it and use it. Correctly. This requires heterosexual couples discussing if they do or do not want a baby. The IUD has lowest failure rate and if I wrote the ACA it would be available with no co-payment for the IUD or for insertion. If you are using birth control pills, keep in mind that the average number of missed pills/month is four (condoms make an excellent back-up contraceptive!). 
  9. If you are pregnant, make every effort to breastfeed your baby. Breastfed babies have a much lower risk of many health problems (and breast milk is free!). By one estimate, if 90% of babies were exclusively breastfed for 6 months $13 billion in health care costs could be saved.
  10. Give up trans fats. These are modified fats found in many prepackaged foods and used in many restaurants (except in New York and California, where they are banned from restaurants). Trans fats (the label will say “partially hydrogenated oil”) increase your risk of heart disease, stroke, and type 2 diabetes. Big offenders are frosting in a can, cake mixes, and coffee creamer. People talk about banning sugar, but you can consume sweets responsibly. There is really no safe lower limit for trans fats.
  11. Ditch the fast foods. A study from Michigan tells us eating fast food is associated with obesity regardless of income. Even if you don’t struggle with your weight, do you really want to eat that pink slime and sodium? I get the allure of fast food. I work all day, scramble to pick up my kids at 6, and then multi-task getting dinner on the table, helping my kids with homework, while attacking the Augean stables of laundry. However, fast food isn’t as cheap as you might think nor as fast. My back-up for exhaustion is a meal thrown in the slow cooker in the morning. It takes a little planning, but a healthy meal that costs $7 (or less) and is ready to serve when I walk in the door is hard to beat.
  12. If your doctor recommends a test, ask how it will change your care. Many tests are just not needed, and some carry significant risks. If your doctor gives a lame-ass answer like, “I’m just looking,” get another doctor. Medicine isn’t a fishing expedition. Every test should specifically rule in or out a specific condition.
  13. Don’t ever use a tanning bed. Ever. Using a tanning bed before the age of 30 increases your risk of melanoma (the most deadly skin cancer) by 75%. Melanoma kills more than 8,000 Americans a year. Tanning beds also increase your risk of other skin cancers (squamous and basal cell cancers). The World Health Organization (WHO) has tanning beds on the same list as plutonium with regards to cancer risk!
  14. Use sunscreen to further reduce your risk of skin cancer. An SPF of 30 or more for extended outdoor physical activity and an SPF 15 for every day. Wear UV-blocking sun glasses and a hat for extra protection.

These changes could save more than a hundred billion/year in health care expenditures. 

 Accountable care should be an idea that we can all embrace.

Need more suggestions or have your own? Ask/leave them in the comments.

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