an interview with the Wellness General - Part 2

(part 2 of a two-part interview) by Donald B. Ardell, Ph. D.

As President-Elect Bush works to form a cabinet and to fill other top government posts, word has come from a well-placed source that a new Cabinet-level position is going to be announced any day now that will be devoted to the promotion of self-management concepts. While I was not a supporter of the Texas governor, I must confess that this bold move in itself is likely to convert me into a big fan of our new president-to-be.

I was unable to confirm this story with official spokespersons with the President-elect, but I did manage to obtain an exclusive interview with Dr. David Haber of the Texas Medical School at Galveston. Dr. Haber is widely regarded as the mastermind behind the idea promoting the creation of a new office of U.S. Wellness General. I asked Dr. Haber to describe the concept for SeekWellness.com. The following is off-the-record but reliable.

(part 2 of a two-part interview) see page one

Don: Dr. Haber, you have described President-Elect Bush’s plan to convert the role of the US Surgeon General to that of US Wellness General, sketched the basis for the change and told us a little about how the new president will promote wellness. How about funding this new office? Where will the money come from?

Dr. Haber: We will craft federal legislation that mandates a small tax on junk food --candy bars, packaged cookies, cakes, pastries, ice cream, soda pop, corn chips, tortilla chips, potato chips and the remaining high-fat, high-sugar or high-salt junk foods that constitute over 20% of Americans’ calories (Tufts University Health and Nutrition Letter, 2000). Jacobson and Brownell (2000) estimate that a national tax of one cent per 12-oz soft drink would generate about $1.5 billion annually, and one cent per pound of candy, chips and other snack foods would raise more than 100 million dollars annually.

Don: Once again, I have to say “Wow.” Do you think this will be controversial?

Dr. Haber: Yes, I do. The main argument against junk food taxes is that the government should not pry into people’s personal business. A Washington Post editorial (11/15/99), for instance, belittled Agriculture Secretary Dan Glickman who had recently said “…it is the government’s role to guide Americans into adopting a healthier lifestyle.” The editor argued that we should tackle obesity and inactivity with common sense and self-discipline, rather than expecting government to do it for us.

The editor also asserted, “that taxes for ‘unhealthy’ foods sounds like something the government- always-knows-best social engineers in Washington, D.C., would foist upon us.” Other newspaper editorials have weighed in on the view that a tax on junk food is a bad idea. You, yourself, Don, have raised civil liberty concerns. You wrote in one of your REPORTS (I read them, but am not sure if the governor does), “Don’t we have a right to choose what we eat? Should we also tax those who do not exercise enough? What about those with no sense of humor? Now there’s a group to sock with a big tax hit!”

Don: So, how will the Bush Administration overcome these objections?

Dr. Haber: I’m not authorized to speak (yet) for the new administration but my sense is this kind of limited government involvement (taxing selected lifestyle “sins”) will provide wellness resources that will in turn enhance individual freedom and responsibility as well as the interests of society. Cigarette taxes, for example, reduce cigarette smoking. California voters approved a 50-cents-per-pack cigarette tax in November 1998, and tobacco sales declined 30 percent. Taxes on tobacco products resulted in the reduction of tobacco use in other states as well. Moreover, the reduction in tobacco use was followed by a reduction in lung cancer rates -- by 14% in California over the past decade, compared to 2.7% in states without significant anti-tobacco efforts.

Don: What other ideas will be part of the new U.S. Wellness General initiative?

Dr. Haber: Look for a National Center on Wellness (NCW). The new NCW will do breakthrough lifestyle research. It will also look at alternative therapies (herbal medicine, for example) as well as ways to increase the effectiveness of more conventional activities like exercise.

Don: What about research in the area of consumer empowerment, effective decision-making and the promotion of personal responsibility, which are all foundation wellness or self-management values? Do you see the Wellness General getting involved in promoting these lifestyle choices?

Dr. Haber: Yes. An example is in the area of critical thinking. Since the Dietary Health and Education Act of 1994 eliminated pre-market safety evaluations for a wide variety of dietary supplements including many herbs, vitamins, minerals, and hormones, this issue presents a natural forum for the Wellness General. The occupant of this office will have to enlighten the public about key effective decision-making principles. For instance, dietary supplements may be “natural,” as advertised, but that does not mean they are any less potent as substances that should be utilized only with great care, perhaps in consultation with qualified, impartial health experts. Many dietary supplements dangerously interact with prescription and over-the-counter medicines.

Don: I know you are very busy at present, given that so much has to be done in so little time to prepare for the new government, let alone a major initiative like this one. However, could you take one more minute to tell us if there might be implications in this new post for the quality and direction of managed care?

Dr. Haber: I’m glad you asked that. In fact, the Wellness General will, when the appropriate evidence is assembled, encourage the incorporation of wellness into health insurance plans. For too long, wellness-oriented physicians have had to routinely fudge insurance forms, claiming that patients who presented for self-management skill building, prevention and maintenance purposes were being treated for medical problems so that the insurer would cover the cost of the visit. Managed care must be more receptive to wellness education as a valuable service. I regret that the promise of wellness in managed care has been diminished under the shadow of ever rising medical costs. Preventive care programs have not expanded beyond token offerings. Free prescription coverage has become a thing of the past and managed care plans have been losing money or terminating business. Hundreds of thousands of Medicare managed care beneficiaries, for instance, have been told to find other sources of health care coverage since 1997. We have a study showing that of 506 HMOs examined in 1997, 57% lost money. Managed care organizations that had been making a profit for years reported their first ever losses in 1997. Managed care insurance companies claim that payment rates are inadequate and bureaucratic obstacles are high. The Wellness General must find ways to make it attractive for managed care organizations to promote wellness.

Don: Are you suggesting that the US Wellness General could work to make health insurance more wellness friendly?

Dr. Haber: Absolutely! Based on studies documenting the cost-effectiveness of wellness, the Wellness General may want to consider mandating wellness insurance benefits. We have surveys showing that an improvement in client health behavior lowers Medicare costs, and that positive changes in physical activity, weight management and smoking also lower health plan expenditures within 18 months. We can’t afford to ignore these kinds of results.

Don: Well, this is all pretty exciting. Anything else you want to tell us about the new U.S. Wellness General idea?

Dr. Haber: Only that there will be a national advisory board picked to assist the Wellness General. It will encourage wellness report cards from all the states, promotions designed to measure and compare the quality of wellness offerings among health benefit plans, and much more.

Don: What can we do to support this effort?

Dr. Haber: Pray. Write your congressperson. If all else fails, we will be organizing a million man breath-holding demonstration until we get what we want.

One more thing: If the President-elect asks you to come to Washington, don’t play hard to get! In your case, Don, try to get over your grandmother.

Don: Thank you, Dr. Haber. Good luck.