MAHA, the lofty goal of Making America Healthy Again
Under Robert F. Kennedy Jr.’s leadership, “HHS is taking bold, decisive action to reform America’s food, health, and scientific systems to identify the root causes of the chronic disease epidemic and Make America Healthy Again.”
It’s a lofty goal that I can support, because Americans currently live sicker and die younger than people in other rich nations — nations that spend far less per capita on health care but still can provide care to everyone while we in America leave tens of millions behind.
Today’s posting is my response to Isabella Cueto’s article in STAT News, In Texas, the nation’s MAHA capital, many are frustrated with the status quo in health care. She reported that Gov. Greg Abbott (R), a stark Trump ally, stood alongside RFK, Jr. as he signed a stack of MAHA bills on a desk adorned with a sign reading “Making Texas Healthier.” While I support the concept, I remain skeptical and distrustful of their motives, including Republican plans to repeal and replace Obama’s signature Affordable Care Act.
The Wellness Objective
As Benjamin Franklin put it, “An ounce of prevention is worth a pound of cure.” But the profit incentives of our system is to treat symptoms and keep patients coming back as paying customers.
The same goes for the curriculum of medical schools. It primarily teaches new docs how to diagnose and treat illness or injury, with almost no emphasis on prevention and the pillars of health (nutrition, exercise, sleep, and stress management); and it feeds the for-profit business model.
American healthcare didn’t used to be that way, and it was once against the law for companies to profit from providing health insurance. That all began to change under President Nixon and the introduction of health maintenance organizations (HMOs).
But there’s more to it. Also needed is a complete reengineering our health care system to prioritize profits over people. Success depends on getting the goals and incentives right, and overcoming the opposition, as I’ve written before.
The Political Opposition
In either case, powerful special interests will stand in the way, able to justify spending a trillion dollars in one election cycle to make sure meaningful reforms don’t happen, at least not ones that benefit the people but impact profits. The goal of such a large one-time investment would be to avoid losing over $2 trillion every year.
That $2+ trillion in potential savings is where it becomes possible to overcome such opposition. A public health reengineering objective of just becoming “average” should be able to achieve the savings I write about, because we currently spend almost twice as much per capita (or as a percent of GDP) as the average of other nations.
U.S. National Health Expenditures in 2023 was $4.9 trillion. That’s $14,570 per person and 17.6% of GDP. The accounting of health care spending last year (2024) is expected to exceed $5.3 trillion, growing another 7.1% in 2025. So, half of that is the $2+ trillion I reference. But it goes beyond that.
The $2 trillion number I cite is just an estimate based on improving care delivery efficiencies to match that of peer nations, possibly with a single-payer system like Medicare for All. But what if we did better than average? And what if we added in the wellness impact of RFK Jr.’s Make America Health Again initiatives? It would seem that a healthier workforce would not just require less care. It would arguably be more productive, with people able to work longer, further reducing care costs as they age.
While working years ago as a Sleep Economist, I explored the macro economic impact of population sleep wellness and developed a computer model with the aim of predicting the savings potential. I concluded that a public health emphasis on sleep wellness alone could realistically deliver benefits of well over $1 trillion per year. And then there’s the impact of nutrition and exercise that RFK Jr. is touting.
We Don’t Understand Large Numbers
“A billion here, a trillion there, and pretty soon you’re talking real money.”
As a species, we all seem to have a hard time understanding exponential growth and really big numbers, and politicians can use that against us. It seems hard for most of us to tell the difference between any number that ends in -illion, and the more zeros you add, the worse things get.
The image at right depicts $1 trillion stacked in pallets of $100 bills. Another way to visualize it is with this video.
In one experiment, people were asked to rate the effectiveness of proposed COVID-relief packages. The responses differed sharply when the options were presented in per-capita amounts. Giving everyone $1,200 was seen as much less effective than giving them $24,000. But the reaction was negligible when they were presented as national total amounts of $100 billion versus $2 trillion, even though the ratio was the same in each case.
So, instead of describing how much our entire nation spends on health care, maybe we should avoid using the $4.9 trillion for 2023 and instead stress the $14,570 per person reported by Centers for Medicare & Medicaid Services.
A Rather Unique Perspective
Here’s a summary of what has influenced me. It’s not meant to be a resume but to show the evolution of my bias, politics, and health care perspectives.
- IBM enterprise (hospitals) to consumer (PC) marketing & strategy
- Broadband and digital home consulting with focus on sensors & telehealth
- World Futurist Society focus on functional medicine and health tech
- FCC Consumer Advisory Committee
- Two positive experiences with consumer lobbying & grass roots activism
- University of Texas sociologist study of public response to novel new treatment
- Modern Health Talk sharing perspectives to influence the future
- Sleep Wellness impact on individuals and society
- Austin’s Body Hacking conference
- Retirement move to 55+ active adult communities
1. IBM enterprise (hospitals) to consumer (PC) marketing & strategy
The first half of my 30-year IBM career was focused on technologies serving internal operations and large corporate accounts, including hospitals. For example, I installed patient accounting and medical records systems at Santa Rosa, the largest hospital in San Antonio. The second half of my career shifted, however, to supporting PC-based consumer applications and working on international standards for sensors and wireless networks.
2. Broadband and digital home consulting with focus on sensors & telehealth
By the time I retired from IBM, I had developed an interest in wireless and fiberoptic broadband Internet access, thanks to its application for telework, distance learning, and telemedicine. I founded CAZITech, an independent consulting firm serving large corporate clients including Siemens and 3M.
3. World Futurist Society focus on functional medicine and health tech
I always had a knack for extrapolating trends and predicting future opportunities or threats, and that sparked interest in the World Futurist Society. I was already seeing problems with the business model of our nation’s “sick care” system and how innovators were attempting to break the model through functional medicine, concierge billing, and medical tourism.
4. FCC Consumer Advisory Committee
As a digital home consultant, I held a volunteer position with the FCC, serving in three working groups: advanced technology, homeland security, and rural & underserved communities. While I’d fly to D.C. several times a year on my own dime, that gave me an opportunity to visit my mom in Fairfax. It also helped expand my views on problems facing rural hospitals and family doctors, as well as the potential of telehealth.
5. Two positive experiences with consumer lobbying & grass roots activism
Twice I was part of small groups who successfully took on powerful and politically connected corporations, learning important lessons in Extreme Democracy. The first time it was with a dozen friends who were able to kill a bill proposed by AT&T that would have banned municipal Wi-Fi. It was a top priority for the company, because they planned to profit from selling Internet access. With millions at stake, they spent accordingly, with over 100 paid lobbyists, but our grass roots effort prevailed. The second experience was cofounding Homeowners of Texas, a 501(c)(4) nonprofit that took on the Texas Association of Homebuilders and got an abusive state agency abolished outright.
6. University of Texas sociologist study of public response to a novel new treatment
I took part in an interesting experiment sponsored by UT’s sociology department. The objective was to study human reactions to a promising but unproven approach to battling a global pandemic. This was before COVID and MRNA vaccines and instead investigated injectable nano-bots designed to seek out and destroy invasive pathogens. The lessons learned were about how people react with distrust when afraid of something new.
7. Modern Health Talk sharing perspectives to influence the future
Some people don’t understand why I’d create a website and write hundreds of articles about healthcare technologies and policies but with no compensation for that work. In my view, it was all worth it to share helpful perspectives with others; and even the tiniest impact on a the future of a multi-trillion dollar industry, and the society it serves, would be rewarding enough. I value what I learned in the process, even with no income.
8. Sleep Wellness impact on individuals and society
While helping a friend scale his Austin sleep wellness business, I applied my expertise and interest in lighting to improve sleep quality. To better understand the beneficial impact of good sleep, I had to find ways to explain it in consumer terms. Functioning as a self-described Sleep Economist, I developed the computer model mentioned above and worked to expand those observations into population sleep wellness.
9. Austin’s Body Hacking conference
My interest in sleep wellness caused me to attend this very interesting conference, which explored the many ways people were using wearable, implantable, and ingestible technologies to address different physical disabilities, an interest of mine. I learned how many of them were willing to experiment on their own bodies, without relying on any regulatory oversight.
10. Retirement move to 55+ active adult communities
Because I introduced IBM to the emerging smart home market before retiring in 1999, I was already thinking of how such technologies could help people age-in-place and avoid or delay high cost institutional care. That interest caused me to start my consulting firm and later write as founding editor of Modern Health Talk. It also caused me to seek out communities that cater to the aging demographic where homes are designed specifically for that. I continue to learn, as a technology consumer myself, what products and home features people of my age value and will actually use. I’ve long promoted the concept of Universal Design, where products are NOT designed for the elderly but for everyone, regardless of age or ability.
ABOUT THE AUTHOR
Wayne Caswell is a retired IBM technologist, futurist, market strategist, consumer advocate, sleep economist, and founding editor of Modern Health Talk.
