Most of the Congressional debate for health care reform revolves around ways to extend reimbursement for sick care. However, paying for more of the same fragmented, costly care isn't reform, it's madness.

The $2.2 trillion health care system, the costliest in the world, requires a new top-to-bottom vision, and although the 600 doctors and health professionals gathered at the Institute of Medicine's Summit on Integrative Medicine last month didn't agree on everything, they reached a resounding consensus about the need for Americans to change their health habits. Yet how can that best be accomplished?

With a primary shift toward health promotion, disease prevention and wellness, a revamped health care system could put the brakes on the disastrous trajectory predicted for 2012, in which total health care costs would equal 20% of the Gross Domestic Product (GDP). Providers, employers, and even insurance companies finally concede that the US would fall behind the world's nations in every imaginable sector if one out of every dollar of our productivity went toward health care costs.

For over 30 years, the National Wellness Institute has been reporting that 8 out of 10 Americans suffer from chronic ailments derived from unhealthy lifestyles: poor diet, inadequate physical activity and unmanaged stress. Yet the difficult task of behavior change has always fallen on individuals, without much support from the medical system or their doctors.

In addition, cultural support has been lacking for the most at-risk populations, often minorities with higher rates of diabetes and obesity. At present, there are more obese Americans than overweight ones-an almost unthinkable statistic.

Cultural support for healthy lifestyles starts with community activists demanding bike paths, public parks, safe streets, farmers' markets, fresh food options and more from their local governments. Together with cooperation from industry, government, health care, and public health officials, pressure can be placed on developers to build environments that provide opportunities for physical activity. Teachers, parents and consumers can demand that Big Food stop advertising cheap, non-nutritious, calorie-dense, processed foods to kids and young adults. Schools can offer nutrition and PE classes again, and lunch programs can teach kids about healthy choices-and provide them!

Should Your MD Get Paid to Teach Wellness?

"Lose weight, stop smoking, start exercising, and cut down on your stress-and I'll see you next year for your physical." Everybody knows that the once-a-year admonition from your doctor rarely translates into new health habits.

A new tier of health coaches can supply the support and encouragement needed for Americans to begin their journey towards maximizing personal health. Health coaches should be part of every public clinic, medical office and hospital wellness center. They should be reimbursed by insurance companies, or be part of the first-access tier of Medicare, Medicaid, private insurance companies and corporate wellness programs. Even Dr. Mehmet Oz suggested that health coaches should be considered a central part of health care reform to CNN's medical reporter Dr. Sanjay Gupta.

Instead of medical doctors expecting to be reimbursed for providing health promotion and wellness services (at rates exceeding $200/ hour), health coaches could easily provide this service at one-fifth the cost. They would also present a more friendly, accessible, peer-support approach to individuals. The specialized training of medical doctors is best directed to complex cases, whether acute or chronic.

The entire continuum of care needs to be re-examined and opened up to include reimbursement for health professionals that investigate the foundational causes of chronic illness, and who understand and have specialized skills in countering the ill effects of unhealthy lifestyles-professionals such as Nurse Practitioners, Naturopathic Doctors, and Traditional Chinese Medicine doctors, Homeopathic doctors, and Chiropractors.

For too long, there has been an active collusion barring the advancement of these professions by certain medical organizations with insurance companies, and the public has suffered as a result.

When these allied health professionals spoke up, demanding inclusion at the reimbursement table at the Summit on Integrative Medicine, a few medical doctors such as Dean Ornish, MD, championed this democratizing of the medical landscape, but others kept insisting that their own practices could accomplish wellness services, if only they were properly reimbursed.

However, reimbursement for lifestyle counseling should not have to include the major overhead encountered by medical doctors, including their clinical offices, costly tuition loans, high-tech equipment, numerous staff and billing clerks.

It's been said that the US health care system is neither healthy nor much of a system. I believe it's always darkest before the dawn of a new era, and these dark days of an ailing system must mean the light is about to break over the horizon.

Bringing health coaches into the US health care system can address the colossal "elephant in the middle of the room"-that the burden of disease and related health costs can be dramatically lowered through healthy behavioral change. Learning to move more, eat well and less, and de-stress often, is not only a prescription for a better life, it's an Rx for US health care reform.



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