45,000

45,000. That's the number of deaths that one Harvard study links to patients who lack medical insurance in the US. Could that number be hacked way down? I have my own hunches, but before getting into that dicey discussion--the cost of hospitalizations and single payer insurance and so on--I have some simple Chinese-inspired thoughts about health.

Just think how much money we might save if we just focused on food and feet.

What if we focused less on medical care and more on public health--especially what we eat and how much we walk? I look around me in western China, a less prosperous part of the country, and see people with gleaming white teeth, people who probably make very few visits to the dentist.  They don't pay a lot for dental care, but they eat good food and eat very little sugar. I see nimble-bodied people who carry all kinds of loads, who walk at all kinds of speeds, and accomplish amazing things at all ages. People are active. Don't get me wrong--I'm sure lots of people are left outside the medical system who do need care, but I also see a culture where lifestyle (and preventative practices) trumps medical care (and reactive practices).

Isn't that a sane way to save lives and money?

What if the US took the car keys from everyone and made us walk a little more a couple days a week? What if we radically shifted our healthcare discussions from reactive policies (after we're sick and in need of medical care) to preventive policies (to keep us from getting sick). We need a shift in personal lifestyle as dramatic as the shift we had when the EPA put curbs on some frightening environmental practices a generation ago. We desperately need a Rachel Carsons for personal health--someone to shake us into eating right and walking a little more.

It's not so convenient to walk? True--but what if convenience is killing us?

China, of course, doesn't have all the answers. China does support a culture with active people who tend to have vegetable rich, low-fat diets, but it also has a huge problem with air pollution and other things. China needs the equivalent of the EPA--it desperately needs regulations on air quality and on the burning of fossil fuels. But the US could pay attention to the life style of most Chinese residents--and the huge implications of that lifestyle for medical costs.

Wouldn't eating better and walking more save millions, maybe billions of dollars in the healthcare system?

But back to 45,000. Our best intentions don't necessarily keep us from getting sick. We come with whatever genes we've got, and some environmental issues are beyond our control. Stuff happens. We all get sick. I for one, would like to think I live pretty lightly on this earth, but damn! Every organ in my body has a medical story. There's that bizarre little teratoma, straight out of science fiction. Nobody knows where my giant cavernous hemangioma came from, one that almost shut down my liver. I could go on. And what about the head trauma with that bike wreck? If it weren't for medical insurance, I'd probably be hanging out in a homeless shelter somewhere.

I do believe in single-payer insurance, and think it's a basic right. I'd like to see us blast into that 45,000 number, and I think decent insurance for every human being would be a step in doing so. I don't believe in unlimited insurance for every possible procedure at every stage of life, especially near-end-of-life procedures, but I suspect that some basic, very basic, universal care is sane. I realize it won't be cheap.

So what can we do to offset the expense? If you ask me, we can pick up the other end of the stick and take seriously how much we walk and how much fat we consume.

http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917