“But Functional Medicine is so expensive!”…or is it?

We hear this all the time.  In fact, it’s probably one of the most common objections/comments we hear (second to “you saved my life”, of course)  (True story, actually.)

If you’re a non-insurance doctor yourself, you’re probably tired of hearing it.  If you’re a patient who has sought Functional Medicine care, you’ve probably said it.

I wouldn’t blame either one of you.

On its face, Functional Medicine requires the patient to spend quite a bit of money up front, even if the doctor isn’t asking for the nebulous multi-thousand-dollar, all-inclusive care plan (I hope none of the doctors reading this are doing that – it’s tacky and passé, and ethically shaky at best).  But anyway, even if the Functional Medicine program in question is structured to be pay-as-you-go, it’s still going to cost plenty to get started, if you have a chronic condition and the Functional Medicine provider is doing his/her job.

I’m going to make a bold statement: Functional Medicine care is actually, probably, ultimately, … the cheapest way to go.

Wait–what?

Yes.  To understand why, one must look beyond the (sometimes-shocking) price tag.  To do that, one must consider another factor, one that is less obvious: Value.

Value, in this case, can be defined as the results, improvement, satisfaction, or any other positive effect gained from the expenditure, comparing it to said expenditure, and making a judgment call.

But one must also do the same for the other available avenues of health care.

When someone says that Functional Medicine is so expensive, they’re probably comparing it to conventional medicine.  After all, it’s only a $30-50 copay, right?

Wrong.

What about that check that you write out every month to the insurance company (or, alternatively, what about that massive deduction that gets whacked from your paycheck every pay period)?

And what about the ever-increasing deductible you have to meet each year in order for insurance coverage to start kicking in?

I encourage all of us to go back over our bank statements and paycheck stubs and total up the actual costs for a single year.  I recommend using 2016 as your model year, because the costs aren’t going to go down; they’re only going to go up from here.

If you’ve noticed, I’ve only talked about price so far.  I haven’t even begun to holler about value yet.

Let’s go there now.

What do people get in return for their thousands of dollars annually?  If they’re not sick and they don’t have an issue all year, then they get nothing except peace of mind.  (Peace of mind is worth something in itself, however, and it is indeed part of that intangible value.)

For people who do have health issues, most of them derive some benefit from their conventional medicine-based insurance.  The benefits themselves are somewhat questionable, however.

Sure, that statin drug sure keeps that cholesterol down, but apparently nobody got the memo about the cholesterol myth having been debunked.  The side effects of those drugs are pretty real, though, and they do lead to a lot of scary problems.  Wouldn’t it be wiser to find out why the cholesterol levels are high in the first place?  (Hint: it’s not a statin deficiency.)

Sure, that corticosteroid saves those joints from being eaten by the immune system, but behind the scenes, those drugs ultimately tear tissues down on their own.   Wouldn’t it be wiser to try to figure out what keeps the immune system angry in the first place?

But finding the reasons why something might be amiss takes investigation, which takes a doctor’s time.  And insurance doesn’t pay for that, so conventional doctors don’t tend to do it, unless they have specialized knowledge beyond med school (rare) and exceptionally generous hearts (except that a good heart doesn’t pay the office staff).

So, a doctor has two options:

Option A is that they choose to play by the insurance-dictated rule book.  This allows them to band-aid the most pressing immediate problem in a three-minute visit, and easily pay the bills.  Fair for them, not fair to chronically ill patients in the long term.

Option B is to tell insurance to pound sand, operate outside of their rule book, and form a partnership with their patients, thinking and working outside the insurance box in order to do the necessary investigation and make the necessary recommendations for serious long-term improvement.

If the symptom is a crack in a wall that we all know from collective experience is actually a destabilized foundation underneath, what has a lower price tag: a can of spackle to cover up the crack, or calling out a professional team to come dig under your foundation and stabilize it from the source below?

The spackle at the home improvement store costs less, hands down.  But what did it really do?  You don’t see the crack in the wall anymore.  It looks a lot better.  You might even forget that it was ever there.

Until more cracks form, because the root cause of the issue was never addressed.  Maybe this time, it affects a door frame.  Would some wood glue help?  That’s got a low price tag as well.

But the foundation underneath continues to shift and stray.  What happens when a nearby window cracks?  Replacing the glass is certainly reasonable.  It’s a logical solution with a swallow-able price tag.

But then, the floor starts to slant.  Pens resting on the desk in the home office spontaneously roll off onto the floor.  We could get really creative and pile a few books under the lower desk leg(s).  There–that’s better.  The pens don’t roll off anymore.

This sounds absurd, but it happens every day, with the most important asset we have: our own bodies.

Consider the person who schedules regular visits with their endocrinologist, their rheumatologist, and their gastroenterologist.  After all, they need insulin for their diabetes, steroids for their joints, and Nexium for their GERD, respectively.

That’s a really typical scenario.  And it’s equally absurd.

Sure, their insulin, steroids, and proton-pump inhibitors are all covered by insurance.  So are the every-six-month doctor’s visits.

But those doctors are never going to resolve any of those problems.  They’re just going to refer the patient back to their endocrinologist when their hair starts falling out and they start gaining weight uncontrollably, because it’s probably a thyroid issue.

They’re right about that.  But they’ll never get ahead of the problem.  “It’s just life,” they’ll say, or they’ll blame it on genetics because the patient’s mom had thyroid problems and their dad had diabetes and their sister has nodules on her joints.

When the patient finally gets depressed about it, the psychiatrist will be right there with Prozac in hand.  And when the patient “complains” of a low libido shortly thereafter, another specialist will be right there with Viagra at the ready.

Spackle, wood glue, and glass replacement – all of it.

The underlying problem remains.  And it doesn’t stop.

Nobody ran an autoantibody test and even if they had, they wouldn’t know what to do with the results.  Conventional med school doesn’t cover that.  Neither does insurance.

Decent Functional Medicine training does, though.  A decent Functional Medicine doctor will test for reactive foods, stealthy infections, immune reactions to chemicals (and any FM doc who isn’t doing these things, shame on them).

The Functional Medicine doctor who is worth their salt will investigate the drivers, the factors that destabilize the foundation.  And they’ll work to eliminate them.

So…was the medical version of the spackle, wood glue, and glass replacement all that much cheaper?  It didn’t even look at the foundation!  Was it really all that great a deal?

(No.)

But in our scenario, the proverbial homeowners insurance plan covered it.

But they’re not going to cover the work done by the foundation professionals.

Why?

“Lack of evidence,” they say.

Never mind that there are decades’ worth of well-done research papers written on the subject.

Functional Medicine actually has the capability to look under the foundation and stabilize and repair it.  Functional Medicine can stop the damage path from growing longer and wider.

But to dig under a patient’s foundation and address the real problem, the patients have to be willing to let go of the tendency to let the insurance company dictate every decision, consider the cost versus the value of each avenue, and contract privately with a foundation pro.

I honestly figure that for every $1 spent in Functional Medicine, a patient will ultimately save $10-15 over the next 10-15 years.  And even those next 10-15 years will treat them much better.

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