Time to focus on health care over sick care

Let’s be honest. We do not have a health care system in this country. We have a $3.5 trillion sick care system, in which companies make massive profits providing goods and services to people who are ill. While we can discuss ways to reduce the cost of medical care, I believe that is the wrong conversation. We keep talking about sick care when we should be talking about health care.

Health is not just the absence of disease; it’s the resistance to disease. Healthy people are strong, mentally and physically. They are fit and have efficient energy production at a cellular level. They have a strong immune system that fights foreign invaders but does not turn on itself. They have ideal hormone balance to regulate physiologic function. They have a diverse intestinal microbiome to promote efficient digestion of food. As a result, healthy people feel good, sleep well and have natural energy levels. Yes, healthy people do get sick, but not as often as unhealthy people. And they don’t suffer from the myriad of chronic diseases that plague this country and account for the vast majority of its medical costs.


That said, it’s not just the health of individuals that matters. Equally important is the health of the communities and the environment in which we live. Our bodies are continuously exposed to stresses never before experienced in human history. We have a food industry that profits from addictive products that lie at the root of many chronic diseases. Our workplaces foster a sedentary lifestyle, poor posture and high stress. Contaminants in soil, water and air bombard our systems daily and overwhelm our processes for detoxification. Social media and a hyperconnected society create stress and drive chronic inflammation.

But a quiet revolution is happening. Patients, physicians and corporations are creating their own markets around health instead of disease. Patients are embracing new approaches that focus on healthy foods, physical activity and stress management. Physicians are abandoning outdated insurance models and providing health care services directly to patients. Corporations — including Comcast, according to a recent New York Times article — are investing directly in the health of their employees.


Is it possible to develop a real health care system at the national level? Yes, with a reorientation of policies:

We need better research. We have had significant advances in basic science over the past century, but broader observational research on health has been conflicting, confusing and often tainted with bias from special interest groups. We need a true National Institute of Health.

We need a new approach to food production. Our overconsumption of unhealthy, manufactured foods is a complex cultural and economic issue that is too big to ignore. We need policies to encourage the production and distribution of clean, healthy, natural foods.

We need policies to promote physical activity in schools and the workplace. We sit way too much. Exercise, even walking, has a profound effect on health and a sense of well-being.

We need to regard socioeconomic issues as health issues. Matters of housing, transportation, education and employment have a direct effect on our health and, likewise, on the high cost of disease. We need new policies to encourage the development of safe, clean, thriving communities.

We need a new attitude toward mental health. The U.S. death rates from addiction, suicide and homicide suggest we are doing something horribly wrong. We need to understand better how the brain functions and develop policies to encourage constructive human behavior.

We need a primary care system to tie it all together and provide comprehensive medical services to all people. Ultimately we are responsible for our own health. But let’s face it: Staying healthy takes work. It requires energy that many of us don’t have — because we are not healthy. A new primary care system, enabled by technology and an expanded workforce, could empower us to live healthier lives.

Creating a real health care system would take time and money. But the United States would get a return on its investment in the form of reduced medical costs and a more productive society. A system that focuses on health instead of disease would pay for itself multiple times over.


Dr. William S. Queale is a board-certified internal medicine physician with master’s degrees in exercise science and clinical epidemiology. He is in private practice in Lutherville and can be reached at