Combating Diabetes and Empowering Local Farmers

 

The human and economic toll of chronic disease in the United States has risen to an unsustainable level over the last few decades to the point at which now over 75% of all health care expenses in the U.S. can be attributed to chronic disease. Instead of treating only the symptoms of chronic diseases, we should focus our healthcare dollars on preventing the causes of chronic diseases.

Based on over 25 studies over a 35-year period, Dr. Dean Ornish pioneered the demonstrated effectiveness and cost savings of treating the #1 cause of death in the U.S., cardiovascular disease, with a strict regimen of exercise, a plant-based, whole foods diet, and stress reduction. In 2011, a significant milestone was also achieved when CMS approved this program, called Intensive Cardiac Rehab (ICR), for reimbursement.

ICR participants save taxpayers an average of $17,687 in medical costs over a 3-year period compared with the standard medical and invasive interventional treatment of cardiovascular disease.

In another recent parallel development, Dr. Matthew Longjohn demonstrated the efficacy of a community-based program of 12 months of structured classes on diet and exercise for individuals who meet the criteria of having Pre-Diabetes (approximately 27% of the U.S. population).  Medicare participants in this program demonstrated an average savings of $3800 over a 3-year period compared to the standard treatment of medication, insulin and treatment of associated co-morbidities that arise with individuals who advance to diabetes.

Both of these programs represent the exciting new evolution of Medicare reimbursing for what is becoming known as “lifestyle medicine” in the treatment of chronic disease.

We know that when incomes drop and family budgets shrink, the first meal items dropped are usually healthier foods like vegetables and fruit, and food choices shift toward cheaper starchy and fatty foods with added sugars which are the cheapest way to fill hungry stomachs.

Thus, counties with high poverty rates have been shown to have obesity rates that are 145% higher than wealthier counties and much higher rates of diabetes as well.

This proposal highlights the importance of achieving a Single Payer Medicare For All system and the power that it would have in promoting treatments of disease for all people that are not profit-driven.  

So after we achieve Medicare For All, approximately 305,000 former Medicaid recipients in Arkansas that are pre-diabetics would become eligible for the Medicare Diabetes Prevention Program (MDPP) and many others would become eligible for ICR program. However, we know that tight grocery budgets make it difficult to adhere to healthy diets due to lack of money to buy fresh fruits and vegetables.

With a small portion of the aforementioned savings obtained through these two programs, we propose to launch the Medicare Fresh Fruits and Vegetables (FFAV) program which would give participants in these programs-MDPP and ICR- with incomes up to 150% of the Federal Poverty Level the opportunity to receive Fresh Fruits and Vegetables (FFAV) prescribed by their referring physician and administered by the MDPP and ICR programs.  The individual’s participation in the FFAV program would be voluntary on their part and the program would be in addition to any SNAP or WIC benefits the individual already receives. Their participation in the Medicare For All FFAV program would be for the same 3-year period of time that already shows demonstrated cost savings.

How it works:

Local farmers would be prioritized in procuring contracts with CMS to supply the FFAV program.  The produce could be delivered to the participating program locations for distribution to participants to take directly home. The farmers could coordinate with the program dietary instructors to instruct cooking methods with locally available produce.

Every individual enrolled in the MDPP that receives FFAV for 3 years would still save the taxpayers $200 over 3 years compared to the medical expenses of individuals that are not enrolled in this program. Every individual enrolled in ICR that receives FFAV for 3 years would save the taxpayers over $14,000 over a 3 year period compared to the medical expenses of individuals that are not enrolled in this program.

Given the widespread nature of pre- diabetes and cardiovascular disease in this county and the business case for developing new ICR programs along with the new demand for a large production of FFAV, the Medicare FFAV program could create a steady and increasing demand for local farmers growing FFAV, especially in rural communities, while at the same time decreasing the cost of medical care for this most expensive of populations, thus creating a virtuous cycle of economic sustainability.