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President Obama Has a Health Plan for America (But Is It Good for You?)

"It's nice to see you again." President Barack Obama shakes my hand and smiles warmly.
/ Source: Mens Health

"It's nice to see you again." President Barack Obama shakes my hand and smiles warmly.

I first met candidate Obama a little less than a year ago, flying with him on his campaign plane from Lansing, Michigan, to Boston, on his 47th birthday. Back then, I had mentioned something about the rigors of campaigning, and he glanced around the cabin of his jumbo jet and said, with mordant humor: "I've got 3 more months, and then it gets harder."

That's exactly what brings me to Washington on this steamy day in late July. The hard part has begun.

Men's Health is, of course, a magazine with a mission to improve the health of its readers. Most of the time, it focuses on personal health: what you can do to outrun Father Time, dodge the white coats, and outfox the reaper, such as following this 4-week plan to remake your body into a sleeker, fitter, stronger version of its younger self. That's probably why you read it. Your health is a deeply personal matter, and we're here to be your advocate, one you can consult privately in the happiness experiment that is your life. We're good at it, because we're constantly experimenting with our own lives as well.

But sometimes the deeply personal goes public in a big way. For more than a decade, we've been tracking the growing grumbles of dissatisfaction in the relationships between our guys and their doctors. All sorts of things were getting in the way: denials of insurance coverage, lost coverage, expensive drugs, spiraling costs. And that was during the good times. When the recession turned into a full-blown he-cession, with millions more men than women losing jobs and benefits, it suddenly became a health crisis that was prejudicially affecting our guys. It wasn't just personal; it was systemic. Coordinated action would be required to fix what ailed so many of us.

Fortunately, the Men's Health guy we know in Washington has some say in the matter. Barack Obama was on the cover of the magazine last November, the same month he was elected president. So we put in a call: Would you talk to us about where all this is headed? He accepted.

It makes perfect sense why President Obama wants to reach out to you. Men's Health readers are 12 million strong. You're an educated cross-section of America, and you're smart health consumers. I'd guess that the president looks at you and sees guys he's attended kids' soccer games with, and faced off against at the top of the key. If he can win you over on health care, that's another constituency that won't be tripping up his efforts to reform our system.

That said, I completely understand the motives of the questioners. I'm one of them. My 401(k) tanked, just like yours did, and I was as steamed as you were at the greedy blind men who put my nest egg into the incredible shrinking machine. So when the call went out, post-stimulus package, to lay out another trillion or so for health care, I grew nervous. The money would either come out of my pocket or, years in the future, my kids'.

My nerves jangle when I look at the other side of the health care ledger as well. Seven years ago, I was diagnosed with a 99 percent blockage in my heart's left anterior descending artery, despite my adherence to the fitness and nutrition wisdom in this magazine. A month after my angioplasty and stent, I learned that my 24 hours in the hospital — from diagnosis to treatment to release — cost $27,000, or $18.75 a minute. I had good health insurance, so I paid a small fraction of that. No sweat, right?

When I applied for additional life insurance a few years later, I was turned down flat. Too big a risk, it seems, despite my 4-day-a- week workout habit and my crazy-good blood numbers — my HDL (good) cholesterol more than doubles my LDL (bad) cholesterol. By the grace of my boss (and enthusiastic Men's Health readers), I've kept a job and good insurance. But that shadow on the angioplasty screen still falls over me: If I'm ever out of a job, I will most certainly be out of insurance, too.

We've seen it a million times, when the news teams look for health pathos: Upstanding couple goes from two jobs to zero during an economic downturn. Cobra runs out, and then one or both of them (or heartbreakingly, their kid) takes ill. One stay in the hospital dries up the rainy-day savings, and the continuing care — a chemo session here, a wheelchair there — introduces a debt that can never be cleared. Roughly 14,000 times a day, people see their health care benefits vanish, and they're one slip away from being TV fodder. And as the victims weep on camera, we cut to Washington, D. C., as we have been doing since at least Franklin Roosevelt's first term in office. There, the warring bureaucrats joust for advantage, and little happens. As the president has said, "the default in Washington is inaction and inertia."

And yet global rivals like Japan, Germany, France, and England — along with such lesser economic entities as Taiwan and Cuba — crossed it off their to-do lists years ago: They offer health care for everybody.

Maybe that's the ultimate question that we, as citizens of the most affluent country on the planet, have to ask: Why not us as well?

Before we hear about how the president plans to fix health care, it makes sense to take a little diagnostic journey through what ails us. As a health editor, as a patient, as a father, I've been following the issue with keen interest. In deference to your attention span, I'll break the whole mess down into four main areas.

First, there's history. In the United States, at least, it's not on our side. Franklin Roosevelt, a president who wrestled with his own health problem (polio), was accustomed to tackling big economic woes (the Depression). He wanted to make health care part of the Social Security system, which he championed. In his 1944 State of the Union address, he proposed a "right to adequate medical care" for all. It didn't happen. Later that decade, Harry Truman also fought for that goal, and lost. Lyndon Johnson managed to push through Medicare and Medicaid, but all was quiet until Bill Clinton handed the problem over to an unelected specialist: his wife. The insurance industry, among others, fired doubts (and tens of millions of dollars) into the air, the entire effort deflated, and the First Lady went back to serving tea in the Rose Garden.

Meanwhile, in this same time frame, our allies and rivals were doing the job. As they sorted through the rubble of World War II, the English committed to their National Health Service, which now provides universal, tax-funded coverage to all residents. The French launched a similar miracle, right after we pulled their asses out of the Nazi fire during the war; after decades of reform effort, France now consistently ranks among the top two or three nations on health outcomes and health-systems performance, as ranked by the World Health Organization. The United States of America is hanging around with such other world powers as Slovenia and Costa Rica. We're number 37! Put that on your foam finger, sports fans.

What do these countries have that we don't?

Coverage. That's point number two. Not much to say here, really. Many countries cover all their citizens for everything, while we cover people who are lucky enough to have good jobs at the moment. But that means 46 million of your neighbors will be fed to the buzz saw of medical billing should they fall ill. In 2007, 62 percent of bankruptcies in the United States were related to overdue medical bills.

That unique, "made in the U.S.A." human tragedy aside, a lot of the noise you hear about health care reform has to do with point number three: choice. With justifiable worry, you hear questioner after questioner, pundit after pundit, intone variations on the theme, "who decides who will live and who will die?" The way many theologians see it, God is the decider. But a lot of mortals are involved as well: doctors, nurses, treatment panels, medical researchers, health-insurance review boards, and — in the scary new world — possibly government screeners.

That last scenario comes up all the time when health care reform is discussed. One sure way to take the air out of the Reform Blimp is to suggest that in some vast new bureaucracy, staffed by the health care equivalent of postal workers, Grandma's request for a new IV bag would be reviewed (and probably rejected) by government drones. My reading of the legislative package says no such thing; humanitarian issues aside, Grandma votes (unlike her slacker grandchildren), so interested parties want to keep her happy. That is, alive, with no pissed-off relatives hanging around making noise.

But it's no myth that people are denied treatment because it's just too expensive. That's known as "the system we have now." But it's not anonymous government workers casting the thumbs-down. It's functionaries at our nation's giant, hugely profitable insurance companies. Right, the same ones who rode out the recent economic downturn while sitting on comfy pillows stuffed with greenbacks. Meanwhile, it's become almost a cliche of health care reportage to see a grieving widow discuss how, even though they had insurance, her cancer-ridden husband was denied treatment because the drug therapy that might have helped him was deemed "experimental" — that is, not covered by their insurance plan.

In 2007, the state of Connecticut launched an investigation of more than 800 short-term insurance claims that may have been wrongfully denied by two Assurant Health insurers due to "preexisting conditions." It's a common dodge, but it's denial, pure and simple. (They agreed to pay $2.1 million.)

As far as I know, nobody has revised the Hippocratic oath to "first do no harm, but second, ask the insurance company if it's convenient to pay the bill." If the issue of choice is truly important to us, we might want to place it beyond the profit motives of companies and the career goals of individual doctors.

And that brings me to point four in this whole battle: profit. In this country, we revere the free market, and justifiably so. Ours is the most powerful nation on earth not because we have really swell national parks or the best of the international "Idol" shows, but because we have the most money. Free enterprise works.

Except when it doesn't. In "Sick Around the World," a health-care episode on Frontline, an official in Taiwan — one of the architects of that nation's all-inclusive health care plan — was asked if he took anything from the U.S. system as he was building the Taiwanese plan from scratch. "The American [plan] is not really a system you can copy," he said. "It's a market." The market's a good thing, as many Taiwanese know. Where else will you sell your cheap plastic stuff? But you can't trust the market with everything. In many matters of national import, we Americans leave it to the government.

I'm thinking of defense, schools, and the National Institutes of Health, just to name a few. Yes, these giant institutions have their problems, but they are founded on national goals we all share: to protect ourselves from enemies, to ensure that our kids wind up smarter than we are, to find ways we can live to see Super Bowl LXXXVIII. Nobody decried socialist science when we set foot on the moon, or when the H1N1 virus went global. The government's supposed to handle that stuff.

And even as we hear accusations of "socialized medicine" from certain quarters in the current debate, those same shrill voices never call for a rollback of Medicare or Medicaid, or suggest that the Veterans Health Administration stop being so fussy over the health of former soldiers. Medicare and Medicaid are rated higher than commercial health plans are by the people they serve.

I'll ask again: Why not the rest of us?

The President leads me to two chairs at the end of the Oval Office, opposite the big desk where the buck stops. You know the chairs I mean; in photographs, the U.S. president sits on one side, and the top guy in Honduras, Poland, Ukraine, or Graceland is on the other. Only when I was there, the 12 million Men's Health readers were in the guest's chair. I hope they took a photo.

A couple of days before, during a video town hall meeting with AARP, the president had mentioned his mother's struggle with uterine and ovarian cancer. So I ask him about it.

"When my mother contracted cancer, the insurance companies started suggesting that, well, maybe this was a preexisting condition," he says. "Ultimately they gave in, but she had to spend weeks fighting with them from her hospital bed, writing letters just to get coverage for insurance that she had already paid premiums on. My grandmother, who raised me, had good health insurance through her job. So between the two of them, it really offered a contrast in terms of how much peace of mind a good health care plan could provide. Those two examples helped shape how I look at things."

He thinks about it a bit more, and then continues. Men's Health readers are on his mind. "My grandfather had prostate cancer, which means that I'm very well aware of some of the specific concerns of men, but also the importance of prevention. The fact that my mother had a weight problem, my grandmother smoked — all those things have also drilled into me the importance of wellness as a critical component of improving the health of the American people."

During previous administrations, we've spent a lot of time looking for a smoking gun. This time around, we're just hounding the first smoker. Of course, we'd just been through a huge hullabaloo over the president's continued nicotine habit — a controversy I inadvertently touched off on the campaign plane last summer when I asked him to tell me the story of his last cigarette. Hey, I thought he'd quit.

I heard something completely different in response: "There have been a couple of times during the course of the campaign when I fell of the wagon and bummed one, and I had to kick it again. But generally it hasn't been a huge problem with huge withdrawal symptoms. But I figure, seeing as I'm running for president I need to cut myself a little slack."

Since then, it has been the story that just won't die. When he signed the landmark antitobacco legislation in June, giving the FDA unprecedented power over how cigarettes are marketed, his Men's Health confession surfaced once again.

But here's the thing: The Obamas chafe at being held up as health paragons the rest of us need to emulate. I'd bet that was part of the thinking behind the president's jaunt, with the vice president, over to Ray's for a Hell Burger. (Or perhaps it was just to find something to occupy Joe Biden's mouth for a while.) Likewise, the First Lady has taken her staff for lunch at Five Guys. The Obamas are dealing with family histories and personal enthusiasms and foibles, just as the rest of us are.

The president certainly doesn't need any extra health advice; as he often says, he has a doctor following him everywhere he goes. But he has set a good example in maintaining coverage, whether he liked it or not.

"Even when I was a community organizer — I was paid $13,000 a year — I benefited from the fact that the guy who hired me insisted that I get health care as part of the package," he says. "And, you know, at the age of 24, 25, you think you're immortal. So I was thinking to myself, boy, I could use that money to pay the rent. But he was very firm about everybody having health care, and I think that he did me a great service during that time."

I ask what role self reform will play in the healthier world order he envisions. (Take responsibility for your health by starting with the easy changes in this list of the 100 best fitness tips ever.)

"Personal responsibility is going to have to be a component of it," he allows. "But I think it's very important, before we start talking about personal responsibility, just to be clear about the facts. We spend more on health care [each year] per person than any other nation on earth. It also turns out, contrary to people's assumptions, that we are actually a little healthier than Europeans and some of our other counterparts, primarily because our smoking rates are much lower. Now, if the current obesity trends continue, that could reverse itself. But not only do we smoke less, but we have a younger population."

Still, the wine-swilling French are pretty healthy, and they pay half what we do for health care per person. (In the United States, we spend 16 percent of our gross domestic product for health care; in France, they get by on 11 percent. And note: They cover everybody for that amount, while we leave 46 million people out.) That's why the World Health Organization, which ranked countries by the health and fairness of their systems, isn't as sanguine about U.S. prospects. I ask the president about it.

"I don't know that particular statistic," he responds, "but when you factor in things like infant mortality, longevity, various indicators of health, we are not at the top of the pack, despite the fact that we spend 50 percent more than anybody else. And it's important for us not to assume that's because we're sicker or because we are getting vastly greater care. It's just that we have a very inefficient system. We don't get the same bang for the buck."

He warms to this theme. "It's important for us to recognize that even if Americans were a lot healthier than they are now — had reduced our obesity rates below where they are now — we still would have probably one of the most inefficient health care systems out there. So how we change our delivery systems, how we make sure that people have coverage so that they're not going to the hospital for very expensive emergency room care — those are all issues that have to be dealt with as well."

At this point I mention that since he's been beating the drum about efficiency, I've explained to my cardiologist and G.P. that, yes, they will have to share my blood test results. (C'mon guys, play nice; the president says so.)

"That's what they have to do," he says. "Look, obviously if you have the best care in America, you have the best care in the world. We have great doctors here, we have great hospitals. The technology that has been developed — oftentimes through free market initiatives — can greatly enhance people's quality of life. And a lot of your readers are, if they're like me, weekend warriors on the basketball court. They're looking at knee replacements and hip replacements so they can stay active. Those things do cost money."

Clearly, the president, with his silky jump shots and deceptive lefty drives, intends to keep running the court with young aides like Reggie Love for a long time. And to do that, he'll need to have the wheels to stay in the game. He'd like you to have them as well.

"I think one of the changes that has happened — even since I was a kid — when I looked at my grandfather, at 55 he already looked old," he continues. "These days, at 55, people are in the prime of life. It's a sign that if you have good health care, if you have the capacity to exercise, if you're able to take care of yourself — and a lot of that ends up being tied to economics — then people can be healthier than ever. But unfortunately, a lot of people don't have those same options. And that's part of the push behind health care reform — how can we make sure that all of us have the options of living healthier lives, which in turn will save us all money in the long term?"

Around the time of our first sitdown, last year, there was a lot of questioning in the air about whether Barack Obama might be too skinny to be commander in chief. Might a big guy world leader — like former Russian president Boris Yeltsin in his fleshy prime — push him around? U. S. soldiers who have greeted President Obama since he took office seem to rally behind him. But that didn't stop me from raising the issue again. The week of our interview, news had broken that obese citizens were absorbing more than 9 percent of total medical spending every year, or up to about $147 billion. And with childhood obesity rates pushing into the one-fifth range, we're bringing along a new generation with trend lines heading in exactly the wrong direction. So I ask the president if we need a war on obesity, similar to the war on cancer launched by Richard Nixon, and if a skinny guy like him could be commander in chief of such a war.

"Well, first of all, I don't think it's a war," he says. "As I said, my mother struggled with weight — and I know that some of it was just genetic. But part of it was she grew up in a generation where, unfortunately, women weren't always encouraged to be athletically active. She didn't get into those early habits that my daughters are already in, because they play soccer and are consistently active. So it's an example of how socialization can make a difference, particularly with our kids.

"The fact is, if we are encouraging physical activity for our children, if we're getting them from out behind the TV, if we're working with schools so that you can develop nutritious lunches that are just as cheap as the pizza and tater tots and french fries that they're currently consuming — it wouldn't take a lot for us to reverse some of these trends. It's not as if people have to completely transform their lives or [we have to] sign up all of them for boot camp. What's required is basically that kids play, people are active; we make some slight adjustments in terms of the kind of food that our kids enjoy; that when it comes to low income families, they have access to fresh vegetables and fresh fruits in a supermarket close by that gives them decent value. Those things can make a difference, but would not require radical changes in people's lifestyles." (See for yourself —these 20 small changes will make a big difference in your health.)

Would the president consider so-called sin taxes, on soda and other sugar-laden products, or on activities that sabotage the health of the masses? (When I suggest this, I'm picturing tollbooths on every point of access to Vegas.)

"I actually think it's an idea that we should be exploring," the president says. "There's no doubt that our kids drink way too much soda. And every study that's been done about obesity shows that there is as high a correlation between increased soda consumption and obesity as just about anything else. Obviously it's not the only factor, but it is a major factor."

But even the most powerful man on the planet needs to keep an eye on what's politically feasible: "Obviously there is resistance on Capitol Hill to those kinds of sin taxes," he says. "Legislators from certain states that produce sugar or corn syrup are sensitive to anything that might reduce demand for those products. And look, people's attitude is that they don't necessarily want Big Brother telling them what to eat or drink, and I understand that. It is true, though, that if you wanted to make a big impact on people's health in this country, reducing things like soda consumption would be helpful."

During our first encounter, I pressed candidate Obama on men's health. That is, the disparity between the amount of government research funding going toward breast cancer, compared with the amount applied against the almost equally deadly prostate cancer (roughly 3 to 1). Or the disturbing fact that men die an average of 5.1 years earlier than women. What's more, the president had given me an opening: Earlier that week, he'd included a "gender equity" element in his health care platform, prohibiting insurers from discrimination based on sex. Including against you, guys.

So I ask him: What's in all this for men?

"A lot of middle-aged men are losing their jobs and are going to have a tougher time getting employed," he says. "Now, our first strategy is to make sure they find jobs with good health care. But that's why their ability to buy into some sort of health care plan with subsidies is so important. We know that the costs for men are actually a little cheaper than the costs for women when it comes to health care during childbearing years. But once you get into your 50s and 60s, then men tend to have more problems. So that cohort of men in their 50s up through the time they qualify for Medicare, making sure that they've got someplace to go is critical. Our health care reform plan would give them some sort of security.

"The other thing is, the prevention and wellness requirements that we want to build into insurance can be very helpful for men, because in some cases men may be less likely to get regular checkups and preventive screening. I had a friend in Chicago who started a program with lower-income African American men, who could go into barbershops to have their blood pressure checked and other basic screenings, because they were so unlikely to visit a doctor's office. And if we can make sure that insurance companies for people who do have health coverage are not providing a disincentive for people to go in and get those screenings, I think that can end up preventing a lot of disease as well."

The President again wraps his lengthy digits around my hand and begins to escort me from the Oval Office. As we leave, I spot a huge wooden bowl filled with apples. I recognize that bowl.

A few days earlier, I'd interviewed First Lady Michelle Obama for our sister publication, Women's Health. There was a bowl just like it in her office. In fact, I'd noticed apples on the desks of many of her subordinates, as if a rampage of grade-grubbing schoolchildren had been through the place. Before I left, I grabbed one; I'm always hungry, and fruit pectin is a proven appetite killer. (Check out these 15 other powerful foods that add years to your life.)

When I spot the bowl's twin in President Obama's office, resting on a coffee table within the reach of all visitors meek and powerful, I ask if I might take an apple. He gestures for me to help myself. I note that I took one from the First Lady's office as well. "It was our first step toward health reform," he says.

Granted, a small step. But in such small gestures — an apple instead of a candy bar, a walk instead of tube time — we can make our way out of this health morass.

In the end, this isn't about the sorry history of reform attempts, or how we manage the access and care, or how we slice the $2 trillion health care pie. Instead, it's about a commitment, from each of us to all of us, that we won't let one another suffer unnecessarily.

E pluribus unum— out of many, one — is printed on the dollar, but the concept is bigger than money. It's a social pact we make as citizens, and it's what makes our country great. And health care is, most definitely, part of that.

Or at least it should be.

5 Reasons You Should Care
How the Obama health care reform plan will affect you

By Maria Masters, Men's Health

1. Your premium may go down
The uninsured usually can't afford their treatment, so the rest of us pay hidden surcharges, says Ron Pollack, exec utive director of Families USA, a group favoring reform. This "tax" averaged $1,017 per family in 2008, the group says. Covering the uninsured would lower it, he says.

2. Small business could benefit
The percentage of small businesses providing coverage for employees dropped from 67 to 38 in the past 13 years, says Molly Brogan of the National Small Business Association. Reform could lead to subsidies to help them pay, which could boost the economy as well.

3. Your income may go up
As health care expenses climb, companies shift costs to employees or cut back in other areas. If costs are under control, more of your employer's revenue could go into your pay, says Jeffrey Grossman, M. D., president of the University of Wisconsin Medical Foundation.

4. You might worry less
Right now you're healthy, employed, and covered. Improve your chances of staying healthy withDr. Oz's 25 greatest health tips. But say you develop a medical condition and change jobs. Your new insurance company may deny you coverage, or offer coverage that's unaffordable. Reforms would ensure that you have an affordable option, Pollack says.

5. Your ER care would improve
People who are uninsured often use the ER as a primary care doctor's office. That means they're crowding out insured folks. Three out of four people requiring immediate care have to wait an average of 28 minutes, a government report reveals.
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