Rational Health Plan


The United States cannot afford an ideal health care plan at this time. A health care plan that focuses on creating healthy children that become healthy adults. A comprehensive health plan for 100% of children is a necessary first step to an affordable national health plan.

The national healthcare debate is focusing on universal healthcare an expensive and daunting endeavor. The implementation of a health and development centered proposal for children versus a disease-centered proposal will create long-term savings that make sense.

The first step in any health program must be to insure the healthy physical and mental development of children. While we can discuss the virtues or evilness of socialized medicine nobody can dispute that all children deserve and should receive the highest level of preventive medicine, as should all pregnant mothers. Healthy children are the guarantee of long-term reductions in health and educational expenses over the long term.

If we can create generations of healthier children we will reap the savings for 50-70 years or more. Investing in improving health in the early years will reduce expenses throughout their lifetimes. Our return on investment in children’s healthcare will result in exponential savings over their lifetimes.

A simple example would be in the early diagnosis and treatment of sleep disordered breathing and sleep apnea in children. Studies have shown that children with sleep apnea account for a minimum of 80% of all ADD and ADHD diagnosis. The majority of these children can be diagnosed and treated at early ages and in addition to medication savings these children will perform better in school and in life. The reduction in the costs for special education for a single year will be in the same range as treatment costs. Treatment of sleep disordered breathing in children will be thru removal of obstructive adenoid and tonsilar tissue and early orthodontic expansion of oral and nasal airways.

These two relatively inexpensive treatments would create massive savings in educational expenses but would also be extremely effective in reducing childhood obesity and future problems with diabetes. As a nation, we could go even further and create a health care plan would offer financial incentives to young mothers who breast feed their infants for 12-24 months. Research has shown that this would allow more normal development of oral, nasal and pharyngeal tissues as well as reduce problems related to allergy and asthma. Children fed formula who develop allergies are much more likely to develop enlarged tonsils and adenoids that further interfere with normal breathing and create developmental problems in the oral facial region. As a society we could endorse medical insurance covering the cost of wet nurses for mothers unable to breast feed. This would then make it possible for mothers wishing to spend more time with their children to supplement their income by nursing the babies of mothers unable to nurse due to physical, emotional or societal restrictions such as careers.

In the past it was common for relatives or friends to nurse the babies of a sickly or deceased mothers. During and after World War 2 women entered the work force and the American mother wanting to be modern and scientific listened and believed when told that bottle feeding and formula were best for their infants. Infant formula is made from cow’s milk and cow’s milk is the ideal food. This is true if you happen to be a baby cow however if you are human cows milk increases your risks for allergic reactions that change antibody responses for life. These changes in the nasal and paranasal sinuses create increases in cells that create mucous relative to cells that create serous or fluid. Increased mucous decreases the motility of the cilia, the small fingers that continually clean, filter and remove secretions to enable them to be swallowed resulting in an accumulation of bacteria, viruses and allergens. These secretions also disturb our sense of smell resulting in food choices that cause nutrition depletion and/or weight gain.

At the same time these biochemical disturbances are disturbing an infants biochemical homeostasis (healthy balance) a second more insidious process is also occurring. When infants are bottle-fed they tightly purse their lips and go thru rhythmic opening and closing movements to express formula from the bottle. This creates an unhealthy and unnatural feeding behavior. When an infant is breast fed the baby takes it’s mothers breast into its mouth and expresses milk by flattening the nipple against the hard palate with the tongue. The result of bottle-feeding is a narrowing of the hard palate. The mouth and the nose are like a two story building. If the mouth is narrow (downstairs) the nose is narrow (upstairs) and the baby develops and lives with a compromised nasal airway. If the baby is breastfed, the tongue (the strongest muscle in the human body) causes the hard palate to widen and follow a normal developmental pattern. The wider hard palate (roof of the mouth or downstairs) now results in a wider floor of the nose (upstairs).

The net result of these changes along with airway blockages from tonsils and adenoids may be the single most expensive and damaging preventable development in children. These children have a compromised nasal pharyngeal airway. They have compromised nasal airway due to narrowing and they have a crowded oral cavity, as the tongue is now relatively too large for the mouth. Very often they develop more complex orthopedic and orthodontic problems as the tongue creates developmental havoc trying to maintain an open airway for breathing. Another problem in the nose is that when the tongue does widen the mouth during nursing the roof of the mouth does not descend and very often a deviated septum results as the septum of the nose grows to its genetically determined length.

These children will often develop adenoid fauces (allergic faces) evidenced by dark circles under the eyes, mouth breathing or gaping mouths and other signs and symptoms. One of the most serious symptoms is sleep disordered breathing, snoring and sleep disordered breathing (sleep apnea). 80% or more of children with ADD and ADHD have sleep apnea. These children have less exercise tolerance and are more prone to gain weight and have endocrine disorders due to disturbed sleep.

These are the very changes that lead to adult sleep disorders including sleep apnea. We now know that sleep apnea is strongly associated with diabetes, obesity, high blood pressure, cardiovascular events such as heart attacks and stroke, atherosclerosis. Snoring and upper airway resistance syndrome are associated with fibromyalgia, carotid arteriosclerosis and increased motor vehicle accidents.

The ability to address childhood health must include improvements in the care of pregnant women. Another simple example is to consider the effect of periodontal (gum) disease on general health. It has been shown that periodontal disease creates an inflammatory disturbance throughout the body that affects all physiologic systems. It is established that this increases upper respiratory infections, increased heart attacks, and strokes, worsens diabetes and many other systemic effects. The most devastating effect may me on the unborn. Mothers with periodontal have a six-fold increase in premature and low birth weight babies. This leads to a lifetime of increased expenses. Studies have shown that a major risk factor for cardiac disease as an adult is being a premature or low birth weight infant. The heart attack one suffers in their fifties may have been put in motion before birth. We also know that there are many physical, medical and educational hurtles that many of these children must overcome.

This is not meant to be a comprehensive plan but rather a starting point to examine essential elements of coverage in any health plan that wants to be cost effective and revenue neutral. More likely addressing early childhood will allow long-term savings that can be used to fund a national health care guarantee.

The long-term solution to health care will be more difficult. It is a political hot potato and the answer may lie in recognizing that everyone will not have the same level of healthcare. This idea of tiered health care will be difficult for Democrats to endorse due to constituency and if Republicans propose it they will be accused of “being uncaring Republicans”

My solution to this problem is to institute a national voluntary draft of medical professionals. The national and state governments pay a major cost of all medical education. Even students paying high tuition at private schools enjoy a great deal of public support. If the country would totally fund the cost of medical school (dental school, nursing,optometry,physical therapy, etc) and provide a stipend for living expenses, and refund a percentage of the amount of undergraduate education costs and graduates would then“owe” one year of national service for each year of medical education before going into private or corporate practice. The alternative would be for students to pay the entire cost of their medical education including government subsidies.

This would allow medical professionals to graduate debt free and to practice in a government run system while they continue to develop their diagnostic skills. Doctors who specialize would owe additional years based on length of education. There would be a system that controls cost that would not replace our current system. The savings realized across society would lower costs and stresses on our private health care system.

We would now have a national health care force that could address the uninsured and the poorly served. This medical army would allow our country to guarantee a basic level of medical service, allow doctors to begin their careers without massive educational debt, prevent highly qualified and motivated students from being priced out of careers in medicine. This national system would also be independent of the travails of medical malpractice dilemma this country suffers.

The medical professionals who come through the system will have a choice after they repay their educational loans by serving their country. They can stay in a national care system or move into the private health care system.

A major criticism of our current plan is that it is the most expensive in the world and yet the results are not as impressive as seen in countries with socialized medicine. This is actually the big health care lie!” British Prime Minister Benjamin Disraeli is credited with “There are three kinds of lies: lies, damned lies and statistics.” When we hear statistics on how much better other systems are than the system in our country it is talking about the health of the population not optimal health for the individual.

This country provides the finest healthcare in the world. The problem is that everyone does not receive that level of care. We may never be able to afford optimal healthcare for every citizen without bankrupting the country and destroying our economy.

If as a country we can recognize and accept that tiered health care is a rational alternative to our current system, or even recognize we already have tiered care that has no rhyme or reason and has gaping problems and holes. Medicare, Medicaid, Veterans Medical Care, uninsured, HMO, PPO, indemnity, Fee for Service and concierge medicine all represent tiered healthcare

We can continue to have the world’s finest health but we must also embrace the health care needs of all. The concept and acceptance of tiered healthcare is the only method to control costs and maintain our current system that works so well for the majority of patients.


Dr Shapira is a general dentist in Gurnee, Illinois who places a major emphasis on treatment of snoring and sleep apnea, TM Joint disorders and reconstructive dentistry. He is a pioneer in the treatment of sleep apnea and was a founding and credentialed member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, He did reearch as a visiting assistant professor at Rush Medical School’s sleep service in the 1980’s focusing on jaw relations and obstructive sleep apnea. He is founder of I HATE CPAP LLC and the website www.ihatecpap.com and is the Dental Section Editor of Sleep and Health Journal. Dr Shapira hold patents on devices and methods for early minimally invasive removal of wisdom teeth and collection of stem cells. Use of his technology will substantially reduce costs and morbidity associated with removal of wisdom teeth.