If you were asked what entity spends the most on health care in this country, you’d be correct if you guessed our federal government. Medicare and Medicaid paid health care providers and services about one and a half trillion dollars in 2019.*
The majority of that budget is spent on chronic disease. A chronic disease is broadly defined as a health condition (such as heart disease, cancer, diabetes) that lasts more than one year and requires ongoing medical attention. It also includes conditions that interfere with or limit daily activities.
Drilling down, the Centers for Medicare & Medicaid Services (CMS) tell us that of the top 10 chronic conditions, vascular and heart conditions make up the largest percentage of the list. The number one chronic condition is high blood pressure. Coming in at number two is high cholesterol. Heart disease and heart failure are also listed in their top 10.**
If we follow the money, we see that one of the approved solutions for heart disease and Medicare & Medicaid reimbursement is a program called Intensive Cardiac Rehabilitation (ICR) which was implemented in 2010. ICR programs have been proven to improve the conditions leading to the disease. If you go through an approved ICR program, Medicare or Medicaid will cover the cost. The goal of Medicare is to avoid the immense cost and long term hardship of invasive cardiac procedures, like open heart surgery.
What’s the criteria for getting an ICR program on this approved list?
A) The program has demonstrated in peer-reviewed published research that it accomplished one of or more of the three following goals:
- slowed or stopped the progression of coronary artery disease
- Reduced the need for bypass surgery
- Reduced need for other invasive interventions
AND
B) Accomplished a statistically significant reduction in most of the following criteria (5 out of 6)
- Low density lipoprotein
- Triglycerides
- body mass index (BMI)
- systolic blood pressure
- diastolic blood pressure
- the need for cholesterol, blood pressure, and diabetes medications
There are only two nutrition/lifestyle programs that have been proven (through peer-reviewed published research) to meet the above criteria.
Meaning, they are the only two programs submitted to CMS (Medicare/Medicaid) that work. They meet all the above criteria for improving heart disease risks.
They are the Ornish Program for Reversing Heart Disease and the Pritikin Longevity Program. Decision memos by CMS in 2010 cite approvals per “Congress in §1861(eee)(4)(A) of the Social Security Act and in our regulations at 42 C.F.R.§410.49(c)”.
So, exactly what are the Ornish and Pritikin Programs? They both are almost exclusively whole food plant based: whole grains, fruits, vegetables starchy vegetables, and plant based protein like legumes. Both advise low to no extra added oil. Both advise whole foods over processed. For example, a bowl of whole grains over a biscuit, an apple over an apple pie or juice, whole corn instead of cornbread, etc. In certain menu lists and plans, they may include very limited servings of non-fat or low fat animal proteins (egg whites, fish, dairy). It should be noted however, that nearly every article or interview with Dean Ornish, he recommends steering clear of animal based products for a couple of reasons:
1) Plant protein sources have fiber, whereas animal protein sources do not.
2) Carnitine is present in animal foods which is metabolized by certain gut bacteria increasing TMAO, a substance that is shown to increase buildup of plaque in arteries.***
Wow. It seems that the endorsed solution to improve health, save lives and billions of dollars of health care expenditures is right in front of us.
It’s a whole food plant based diet.
Our government says so and has it written into the Social Security Act.**** And, Medicare pays for the programs. Completely absent from the science and research based criteria and ICR approved reimbursement list are the popular high saturated fat, high animal protein diets. If our hearts and vascular systems are the engines that drive us, shouldn’t our diet be the one that is proven to heal it?
Why isn’t a whole food plant based diet at the top of every diet list and article? Why isn’t there a concerted effort to educate the medical industry on our known science?
The answer may be, again, to follow the money. Plants aren’t as profitable as the Processed Standard Amercian Diet.
Some people think that the plant-based whole foods diet is extreme. Half a million a year will have their chests opened up, a vein taken from their leg and sewn onto their coronary artery. Some people would call that extreme.
Caldwell Esselstyn Jr., MD
**https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Beneficiary-Snapshot/Bene_Snapshot
***https://www.ornish.com/zine/fish-not-allowed-ornish-reversal-program/
****https://www.cms.gov/Medicare/Medicare-General-Information/MedicareApprovedFacilitie/ICR