April 2012

Out on a limb: Body politic

Jordana Bieze Foster, Editor

With the Supreme Court weighing the constitutionality of President Obama’s healthcare reform law as this magazine went to press and another presidential election looming this fall, the topic of government healthcare spending is sure to get a lot of airtime in the coming months. That means we can expect to get used to hearing from certain pundits about how federal spending on healthcare takes away from federal spending in other areas.

Richard Carmona, MD, knows all about those arguments. He served as the 17th surgeon general of the United States from 2002 to 2006, a period when the government’s top economic priority was fighting terrorism in Iraq and Afghanistan. Natural disaster relief became a hot topic for the government during that time as well, in the aftermath of Hurricane Katrina in August 2005. To many elected officials and their constituents, dollars invested in healthcare were dollars that otherwise could have been spent on national security or disaster relief efforts.

But that’s not the way Carmona sees it. Speaking last month at the Diabetic Foot Global Conference (DFCon) in Los Angeles, the former surgeon general argued that investment in healthcare isn’t something that happens in a vacuum.

Those military efforts in the Middle East require more than cutting-edge weapons technology and intelligence operations. They also require personnel to carry out operations—personnel who have achieved and maintained a minimum level of physical fitness and functional health. This, Carmona points out, too often is easier said than done.

“The number one reason why we can’t keep young men and women on active duty after we’ve trained them is because they can’t pass a physical because they’re obese and out of shape,” Carmona said.

Lower extremity practitioners know all too well that a lack of physical fitness puts any athlete at risk for stress fractures and other overuse injuries, a phenomenon that has repeatedly been documented in military populations. If healthcare spending can help keep those soldiers combat-ready, isn’t that investment in healthcare essentially an investment in the military?

A similar argument can be made for natural disaster preparedness. One of the significant challenges in responding to Hurricane Katrina involved patients who were stranded in local hospitals. If intelligent healthcare spending could have prevented one person from developing a neuroischemic ulcer or another from falling and fracturing a hip, then two more people would have been able to help themselves and others during the disaster instead of requiring additional assistance.

“Patients who need daily care affect our ability to be prepared during a national event,” Carmona said.

It’s probably not surprising that Carmona, who served as surgeon general while George W. Bush was president, was frequently frustrated in his efforts to advocate for healthcare during that time. But now, as a Democratic candidate for US Senate in Arizona, he’s hoping for another chance. If nothing else, Carmona brings a unique perspective to the healthcare spending debate that could well inspire others to reconsider their own positions.

See you in November.

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