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Michael Levin: Author Pollan's View of Insurance Reform Supports Investmen in Integrative Practices PDF Print E-mail
Written by John Weeks   

Columnist Michael Levin: Author Michael Pollan's View of Insurance Reform Supports Investment in Integrative Practices

Summary: In a recent column in the New York Times, author Michael Pollan pits big food vs. big insurance, arguing that the elephant in the room in healthcare reform is obesity, and that the solution comes to slimming down. Integrator columnist Michael Levin finds in Pollan's perspective evidence that key characteristics of current insurance reform efforts create financial incentives that support investment in integrative practices. One wonders, with Pollan, whether "Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry." Yet Levin's argument is clear that we may be seeing changes that could stimulate investment in therapeutic approaches which support habit change. Will these changes incentivize insurers to finally invest significantly in health creation?
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Michael Levin: Will requiring coverage for pre-existing conditions stimulate investment in health?
Integrator columnist Michael Levin brings experience in both conventional and integrative perspectives to his commentary on healthcare reform, steeped as his career is in service as an executive in both big pharma and with dietary supplement firms. Levin typically focuses his Integrator articles on economic, nutrition and dietary supplement issues. His most recent column, Pepsico May be Our Guru on How to Reduce Behavior-based Healthcare Costs, stimulated a thoughtful response from Sheila Quinn, Pepsico May Be Moved by Taxes, But For People, Health Has to Be FOR Something

Here Levin steps into a similar zone, the economic incentives for habit change. He sent this column with a note that he was stimulated by a September 9th New York Times column by influential best-selling author Michael Pollan: "Pollan's op-ed opened my eyes to a new opportunity for integrative medicine under insurance reform (that is, if denial of coverage due to pre-existing disease becomes illegal). Interesting." Levin italicized sections that are direct excerpts from Pollan's column. I placed Pollan's name before them. Are we seeing change that may stimulate investment in therapeutic approaches which support habit change? Will this incentivize insurers to finally invest significantly in health creation?


Insurance Reform: A New Opportunity for Integrative Medicine?

Michael Levin, Health Business Strategies

[In this column, Michael Levin takes off from comments in Michael Pollan's
recent article Big Food vs Big Insurance, New York Times, Sept 9, 2009.]

Pollan: Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.

In his Sept 9, 2009 op-ed piece "Big Food vs Big Insurance", Michael Pollan predicts a "sea change" in the relationship between Big Food and Big Insurance. Why? One way by which the insurance industry currently maximizes profits is to reduce it's exposure to future claims. They do this by denying applicants who have pre-existing conditions or exclusing coverage of those conditions. If this strategy becomes illegal, Big Insurance will realize that it is more profitable for insurance companies to keep people healthier longer.

As things stand, it more profitable
to treat chronic diseases than
to prevent them. There’s more money
in amputating the limbs of diabetics than
in counseling them on diet and exercise.

- Michael Pollan

Pollan: The market for prescription drugs and medical devices to manage Type 2 diabetes, which the Centers for Disease Control estimates will afflict one in three Americans born after 2000, is one of the brighter spots in the American economy. As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There’s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.

Might the quest for profit open new doors for integrative medicine? If so, this is an example where greed is good. For example, will insurance companies cover the cost of early intervention programs to manage pre-diabetics? If, as Pollan asserts, type 2 diabetes costs $6,600/year to manage, it might make financial sense to invest, say, $3000 in intervention to postpone the eventual expense.

Pollan: A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.

One item conspicuous in its absence from the healthcare debate is the development of a national database which would track an individual's healthy behaviors. Currently, insurance companies have little incentive to invest in prevention, largely due to the fact that the average length of time an individual is insured by one company is less than 3 years (source: insurance colleagues). In this current scenario, a return on investment must be achieved within that time for the numbers to pencil out. Were a national database available that would make healthy behaviors "portable" such that all insurers would benefit from all prevention efforts over a lifetime (assuming privacy and HIPAA compliance), each insurer could adjust premiums based on risk-reduction programs in an individual's history. Such a database would neatly and largely eliminate the current ROI financial barrier.

Pollan: To keep from bankrupting ourselves, we will then have to get to work on improving our health — which means going to work on the American way of eating.

Might we one day see insurance
premiums adjusted annually based
on such factors as fasting blood
glucose levels, lipid profiles, blood
pressure and H5A1C?

- Michael Levin

The idea of sin-taxing sugar products, which debuted earlier this year in New York as a means to reduce diabetes risk, is not likely to pass. A food is not inherently "bad"; rather, it's the frequency and manner of consumption that drives health risk. Might we one day see insurance premiums adjusted annually based on such factors as fasting blood glucose levels, lipid profiles, blood pressure and H5A1C? Might airlines begin charging based upon total weight (person plus luggage) hauled? Such economic "carrots and sticks" might be just over the horizon, just as a history of smoking began adjusting premiums decades ago.

Pollan: But even if we get a health care bill that does little more than require insurers to cover everyone on the same basis, it could put us on that course ... For it will force the industry, and the government, to take a good hard look at the elephant in the room and galvanize a movement to slim it down.

This "side-effect" from insurance reform might be very good medicine for integrative medicine.

Comment: Levin's work always interests me as I believe that focusing on economic incentives is an under-developed skill in most of the mission-oriented individuals who are drawn to integrative practices. My biggest complaint with big insurance, however, also leads me to question Levin's thesis in this case. That is this: the profitability of these companies, over time, is essentially on a cost-plus basis. That is, the employers and individuals who pay premiums are accustomed to insurers charging for overhead, which includes profits, that is a percentage of total premiums. Thus, the higher the premium, the higher the insurer's profits. To the extent that this is so, ending denials for preexisting conditions just gives insurers a better case for charging higher premiums, and thus higher profits. So why make significantly increased investment in health-improving, integrative services? Please, tell me it isn't so. 

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