Continued from Part I 

3. Integrative approaches to healthcare must be adopted as the standard of care and rigorously studied. This means including in National Health Care whichever forms of helping and healing—whether previously described as conventional, complementary, or alternative—have proven to be most effective and making them available to all Americans in comprehensive and individualized programs; meditation and medication, acupuncture and surgery, group support in sustaining programs of self-care as well as individual diagnosis and consultation in designing them.

4. Transforming the selection and education of health professionals. The health professionals who will sustain and embrace this new commitment to comprehensive care, self-care, wellness, and prevention, must be imbued with idealism and humanitarianism, with a primary devotion to science in the service of people, to patients, not profits. To train and support them, we must create a system which provides a free professional education with an emphasis on wellness, self-care, and prevention as well as biomedicine, and, in return for it, require compulsory public service for all physicians, nurses, and other health professionals.

This system would foster the selection and education of the most committed, gifted, and dedicated healthcare providers regardless of financial background. It will give all health professionals both a scientific understanding of the therapeutic power of self-care and prevention as well as a profound personal experience of these approaches. It will emphasize character, commitment, and genuine concern for others equally with academic achievement.

5. The transformation of the health of our population must begin with our children. In this process, the Department of Education must be understood as a central agency in health promotion and disease prevention. Current school health programs are largely negative—“don’t smoke, don’t drink, don’t have sex, etc. etc.”—and largely ineffective. The school wellness curricula that all states have been ordered to develop are a good first step. They need to be taken far more seriously, closely examined, and carefully implemented. True and comprehensive wellness—including exercise, nutrition, stress management and self-expression—must become a central part of all school curricula and of the lives, and the teaching and learning experience, of all school personnel and of the parents of school children. Those who are teaching self-care must themselves learn and practice it, and the homes that children live in must support their children’s efforts to help and care for themselves.

6. We must create a sane alternative to the current overpriced, counterproductive, indeed, destructive system of malpractice insurance. This new option would separate financial compensation for patients from re-education and punishment of health professionals and hospitals. A national fund would fairly compensate those who have been injured by medical and hospital error (the vast majority of whom, according to a number of studies in New York and elsewhere, do not sue and are not compensated) in a way similar to workman’s compensation. Instead of perpetuating the destructive narrowness of “defensive medicine,” this new approach would provide genuine re-education for erring physicians or—if their offenses warrant it—bar them from practice. This kind of system, which is being successfully used in such countries as Norway and New Zealand, must be investigated and refined to meet US needs.

7. We must remove the baleful influence of the insurance and pharmaceutical companies on healthcare quality and its cost, and make industry serve, rather than exploit, Americans with health needs. This includes eliminating health insurance companies from the health care equation. They

are formed for profit rather than service, and each year add hundreds of billions of dollars ($350 billion according to Physicians for a National Health Plan) of administrative costs, executive pay, and shareholder profits to our health care bill. This measure would require retraining and re-deploying the several hundred thousand managers and workers in the insurance industry—equipping those who are genuinely interested to provide health care and health education.

A national system of health care should have and use its bargaining power to ensure true competitiveness among pharmaceutical manufacturers and thereby significantly lower costs. Elimination of the influence of direct-to-consumer advertising—deplored by health professionals as well as patient advocates at our meeting—would further lower costs as well as reduce unnecessary, propaganda-driven drug-prescribing and drug-taking.

8. We must develop a research program which serves the needs and priorities discussed above, one which helps set the agenda for our nation’s health, rather than one that uncritically reflects a narrow biomedical perspective. The NIH’s 30-some billion dollar budget must be put to the best possible use, with a far more significant percentage—up from the current 2% to perhaps 20%—explicitly dedicated to studying the effectiveness of prevention, self-care, and wellness. An additional 20% of the budget needs to be shifted away from the single intervention studies—one drug or one procedure—on which NIH grants focus, to the study of comprehensive, integrative and individualized programs of care for the chronic illnesses that beset our population and consume our health care dollars, approaches that appear to be likely to produce the best results—for example, nutritional, mind-body, and exercise interventions for arthritis, heart disease, and chronic pain; chemotherapy along with nutritional therapy, acupuncture, herbs, and group support for cancer. Finally, 10% of the budget that is allocated to single intervention studies should be awarded to research on non-patentable approaches, including mind-body therapies, herbal remedies, therapeutic dietary programs, acupuncture, musculoskeletal manipulation etc. etc.

9. We must recover the ancient philosophical perspective, in which the highest quality healthcare is seen as promoting personal, emotional, social, and spiritual fulfillment, and we must develop programs that manifest this perspective. The military’s health care may be more effective than most civilian care because it has allegiance to and is implemented in the service of a greater mission—the defense of our country. A similar and perhaps even more life-affirming spirit—one of enhancing our collective national life and of providing service to our fellow citizens—can be called on and mobilized for civilian health care.

10. A White House Office of Health and Wellness. As we surveyed the changes we were recommending, it became clear to our group that a small but powerful agency at the highest level of our government was required to ensure continued responsiveness to the ongoing and changing health needs of Americans. Therefore, we recommend that a White House Office of Health and Wellness be established. This office (which would in some ways be similar to the White House Offices of Science and Technology and Drug Policy) would ensure that government bureaucracies (including any required for National Health Care as well as the NIH, the Departments of Education, and Defense and the Veterans Administration) are accountable to a vision in which service to all Americans is paramount. The White House Office would help ensure ongoing active engagement of our population in their own care and in shaping the kind of care that will most effectively, humanely, and economically meet all our needs.