At Safeway, this has already happened. Profit margins are lower in the grocery business than in many others, so grocery stores are like the "canary in the coal mine" that sees trends before they affect other businesses.
According to Steven Burd, the chief executive officer of Safeway, "In 2005, our health-care costs for our employees reached $1 billion and were exceeding our net income by about 20 percent." Clearly, this was not sustainable. I consulted with him and his colleagues there (including Kenneth Shachmut and Michael Minasi) to help develop incentives for wellness and prevention services in their health plan. The following year, Safeway's health care costs declined by 11 percent and remained flat in 2007.
What I especially like about this approach is that it is bringing together Democrats and Republicans and labor and management toward a common goal of lowering health care costs, providing universal coverage, and improving the quality of care.
Unfortunately, most insurance companies pay only for drugs and surgery, not for diet and lifestyle. They will pay $30,000 to amputate a diabetic foot, for example, but not a few hundred dollars for foot care and nutrition counseling that can prevent the need for amputation in most people. Most diabetes-related amputations are preventable with scrupulous care, but foot care is not usually covered. Similarly, they'll pay $40,000 for an angioplasty and stents or for coronary bypass surgery but won't cover comprehensive lifestyle changes that can prevent the need for these. I see perverse incentives and disincentives that reward surgical procedures and drugs over preventive approaches throughout medicine.
All of the doctors I know are genuinely interested in helping their patients. However, since we're trained to use drugs and surgery but not lifestyle interventions and preventive approaches, and we're reimbursed to use drugs and surgery but not lifestyle interventions and preventive approaches, it's not surprising that most physicians rely primarily on drugs and surgery. As the pressures of managed care cause doctors to spend less and less time with more and more patients, there is not enough time to talk about diet and lifestyle issues. This is profoundly unsatisfying for both doctors and patients.
Thus, at a time when the limitations and unaffordable costs of high-tech interventions such as angioplasty and stents are becoming better-documented, the power of and cost savings from low-tech interventions such as the diet and lifestyle changes described in this book are also becoming clearer--when they are most needed.
In one of the more extreme examples of how powerful changes in diet and lifestyle can be, my colleagues and I worked with a few men and women who had such severe coronary heart disease that they were waiting for a heart transplant.
Patients with especially severe coronary heart disease sometimes require cardiac transplantation because the heart is pumping blood so inadequately. Unfortunately, there is a shortage of organ donors, so the average waiting time for a donor to become available in most parts of the country is one to two years. (Unlike giving blood, most people are not willing to donate their hearts.) Approximately half of the patients waiting for a heart transplant die before a donor becomes available. And heart transplantation is quite expensive, costing from $250,000 to $500,000 per patient.