What Role Can Dietary Supplements Play in Healthcare Reform?

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As Congress continues tinkering with its proposed replacements for the Patient Protection and Affordable Care Act (PPACA)-a.k.a. Obamacare-the question lingers: What role should supplements play in a debate that touches upon not just our health, but our responsibility to our fellow citizens, the budget, and the economy as a whole?

The answer won’t likely roll around any sooner than an agreement on how to handle healthcare-which is to say: Don’t hold your breath. But one thing we can agree upon right now is that if healthcare costs keep rising, what at this point remains a pressing concern will tip over into full-fledged crisis territory. Assuming it hasn’t tipped over already.

Yet while Washington dithers, the prospect that dietary supplements might help bend the healthcare cost curve is worth examining. And interested parties are getting to work. Notes Mike Greene, senior vice president, government relations, Council for Responsible Nutrition (CRN; Washington, DC), “With changes to the health-insurance system and concerns about how Americans will be covered if they face a health problem, it makes sense that consumers are seeking new ways to stay healthy and be well for as long as possible.” Dietary supplements could be just what they’re looking for.

Leaning toward Supplements

The search for new ways to stay healthy is already leading consumers to the supplement aisle. “We know that more than 170 million Americans feel confident about and use dietary supplements regularly,” Greene says. And who can blame them? “Dietary supplements, in addition to a well-balanced diet, exercise and activity, and a good night’s sleep, make the foundation for smart prevention,” he says.

Erik Goldman, editor and cofounder, Holistic Primary Care (New York City), is similarly cognizant of the industry’s strength. Citing a Nutrition Business Journal report estimating supplement/natural products industry sales of $41 billion on 6% growth in 2016, he remarks, “That’s a lot of supplement sales.”

Goldman also views consumers’ lean toward supplements as a reaction to “turmoil” in the health-insurance sector. “Many people are frustrated with mainstream healthcare, many still don’t have insurance, and many are underinsured,” he points out. “So lots of people have a sense that, ‘I better not get sick.’” And they hope supplements can help.

Not on Washington’s Radar

Whether political leaders, in their attempts to right our nation’s healthcare ship, see supplements in the same light is another matter. As Goldman puts it, “On a systems level, I don’t think supplements are even part of the discussion.”

Greene agrees-to a point. While acknowledging that supplements “aren’t on the radar” for most lawmakers, he insists that “they’ve grown in importance as a result of healthcare reform.” True, the PPACA makes no mention of them; nor do they appear in Congress’s recent attempts at healthcare-reform legislation. “However,” Greene says, “one of the principles of the PPACA is the importance of ‘prevention.’” And this, he believes, helps explain “why dietary supplements continue to grow in popularity.”

For his part, Goldman thinks supplements need stronger advocates on Capitol Hill. “The industry has almost no real presence in Washington and did not really participate in the Obamacare discussions 10 years ago,” he laments. “It’s been equally absent-if not more so-during the current round of Republican remixing. So I don’t think any of the policymakers are seriously considering supplements as part of the healthcare equation.”

Called to Account

On the bright side, some legislators do express strong personal support for the industry; and Tom Price, secretary of Health and Human Services, “is somewhat aware of naturopathic medicine and not averse to it,” Goldman notes. Some Republicans have even shown interest in expanding tax-advantaged medical savings accounts like flexible spending accounts (FSAs) and health savings accounts (HSAs)-“which some in our industry are taking as a good sign,” he adds.

Indeed, Greene lauds FSAs and HSAs for giving consumers incentive “to make smart decisions and take greater control over their healthcare and wellness.” As healthcare costs rise, he believes, “consumers should be encouraged to use products and services that are cost effective and focus on prevention and wellness.”

So to the extent that medical savings accounts can help consumers cover high deductibles and copays, Greene supports them-and thinks that “dietary supplements should be considered allowable, deductible expenses” therein. “It makes sense,” he says. “Tax policy should encourage consumers to make smart healthcare choices using supplements.”

Yet nothing Goldman’s heard so far “indicates that the Republicans plan to include supplements as eligible expenditures under expanded HSAs.” What’s more, the accounts’ penetration among the population remains thin, he says. (Devenir, a provider of HSA services, pegged the number of HSAs at 20 million at the end of 2016.) At best, Goldman thinks HSAs “could be a good option for affluent people who already have pretty good access to supplements and can generally afford them out of pocket.” For others, though, they’re probably not an effective solution.

Got You Covered

And the insurance: What of its stance on covering supplement costs in their plans? While Goldman concedes he’s “no expert on this,” he still bets that major insurers aren’t interested in paying. “They’ll give lip service to the idea of preventive medicine and keeping people healthy,” he says. “But in reality they don’t like to spend for that stuff.” Even coverage for mammograms and prostate screenings “isn’t preventive medicine,” Goldman maintains. “It’s early detection of disease.”

Just as important, he adds, “Insurers don’t have any incentive to save money so long as they can pass along the ever-rising costs. As long as they can continue to raise their premiums-and employers and individuals remain willing to pay them-they have little incentive to save money, especially if they have to spend now to save later.”

At least healthcare providers appear onboard, as “there’s no question that more physicians and healthcare professionals are recommending and dispensing supplements,” Goldman says. His organization surveys its readership annually and recently found that “well over 90%” of primary-care practitioners in the sample recommend supplements for general purposes, he says. Sixty-three percent of the readership is currently dispensing-i.e. selling-supplements in their practices, too, he adds, which is a 34% increase from 2013.

Yet while almost all naturopaths and many chiropractors in the sample dispense supplements in their practices, among MDs the percentage drops lower, at 53%. To be fair, Holistic Primary Care’s readership is “definitely more holistically inclined than average rank-and-file physicians,” Goldman says. Nevertheless, 8% of the doctors in the survey who self-identify as strictly “allopathic” are dispensing. “So yeah, a lot of doctors are getting on board with supplements,” he says.

Bending the Curve

That’s good news for those who want to see the industry prosper. But it doesn’t answer what Goldman thinks is, “in a way, the industry’s great existential question, as far as scientifically proving supplements’ worth goes.” To wit: Does supplementation reduce healthcare costs?

“A significant amount of scientific research has examined dietary supplements,” CRN’s Greene says, “and many studies demonstrate that they have a positive effect on reducing the risk of a disease event.” So to determine whether that reduced risk translates into reduced costs, the CRN Foundation commissioned Frost & Sullivan to develop a report examining disease conditions like coronary heart disease (CHD) and the potential healthcare savings that use of omega-3 fatty acid, B vitamin, phytosterol, and psyllium fiber supplements can generate. Similar reports have examined diabetes-attributed CHD and the potential savings associated with chromium picolinate; the role of lutein and zeaxanthin in reducing the costs of age-related eye disease (ARED), age-related macular degeneration, and cataracts; and the effects of calcium, magnesium, and vitamin supplementation on the costs of osteoporosis and bone fractures. “What they found,” Greene says, “is that healthcare payers, such as insurance companies and consumers, can realize significant cost savings through the use of dietary supplements that have a demonstrable and substantial effect on the risk of costly disease-related events among targeted high-risk populations.”

But Goldman won’t doff his skeptical cap just yet. Cost-efficacy arguments that claim “appropriate and judicious supplement use” could “obviate the need for a lot of expensive drugs and procedures” are based on “theory and conjecture,” he says, and would demand considerably more time and patience than we currently spend on proving the principle.

Looking Ahead

Still, he sees some cause for optimism. The Cleveland Clinic Center for Functional Medicine is running a series of studies comparing patients with chronic diseases like asthma, migraine, type 2 diabetes, and IBS who go through functional medicine protocols against those with similar diseases treated more conventionally in other Cleveland Clinic departments. Along with clinical outcomes, the researchers will measure resource use, healthcare costs, and other fiscal outcomes, the results of which “could be turning points,” Goldman says. “But they just got started with all this a couple years ago and won’t have data for a while.”

So perhaps it’s time to hurry up and wait. “We’d all like to believe that supplement use will lower healthcare costs, and it makes sense that it should,” Goldman avers. “But I’ve yet to see much really convincing data.” Besides, “Let’s face it: Good-quality supplements aren’t cheap. If you’re taking high-end stuff and a bunch of different products every day, you can easily spend $200 to $300-plus per month, all out of pocket.” Which, for some consumers, may be worth it. And if any plan that Congress cooks up were to share some of that cost, it may well be worth it for all of us.

Also read:

Doctors and Dietary Supplements: Using, Recommending, Selling

How the Healthcare Professional Evaluates Dietary Supplements