Healthy living can save health care system, says Mango, GOP candidate for governor

Paul Mango says America can't fix its health care system without addressing a root problem: unhealthy living.

Mango, a Republican candidate for governor and longtime health systems consultant, believes expanding coverage to the best, yet expensive clinical treatment without turning around the country's wellness problem will break the system.

A 2016 Mayo Clinic study found that 2.7 percent of American adults met criteria of living a “healthy lifestyle” in each of the following categories: being sufficiently active, eating a healthy diet, being a nonsmoker and having a recommended body fat percentage.

“We have wonderfully advanced but expensive treatments. We have increased coverage, and we have a population whose health status has deteriorated,” Mango told the Tribune-Review in a recent interview. “If you take those three, that's the trifecta of bankruptcy.”

Mango, of Pine Township, said the advent of “big data” presents opportunities to create patient-centric treatment.

“A one-size-fits-all product makes no sense in a highly diverse, big-data society that can customize things to you and me that are much more efficient for us and for the market,” he said.

That would play into Mango's focus on addressing patient wellness. He said the key to the health care system going forward is figuring out how to positively influence behavior of patients and medical professionals.

The Center for Health Incentives & Behavioral Economics at the University of Pennsylvania recently discussed the topic of “hardwiring” patient engagement to deliver better health, envisioning the use of technology to provide patients with virtual support through mobile devices and to track behavior and provide feedback. These interventions would be customized to the individual's life and preferences and aim to press behavioral changes.

To illustrate his critique about expanding coverage without addressing underlying health issues, Mango pointed to the opioid overdose epidemic, which he considers to be “the biggest health care crisis in the history of the commonwealth,” he said. “And that's after we expanded Medicaid by over 750,000 (people).

“We're not focusing on the real issue that we have and the real imperative that we have, which is how can we begin to impact and improve people's wellness and health and not just treat illness,” he said.

Mango said he “absolutely” supported expanding Medicaid but said he would have taken a different approach than Gov. Tom Wolf, a first-term Democrat.

“All he is doing is perpetuating a broken system,” Mango said.

He said he would have sought federal waivers for Medicaid and the Affordable Care Act exchange rules. According to the Kaiser Family Foundation, the Obama administration denied Medicaid expansion waiver provisions sought by states to reduce coverage or impose a work requirement for eligibility.

Approved waivers included using Medicaid for premium assistance, charging premiums above the federal limits, eliminating non-emergency medical transportation and offering healthy behavior initiatives to reduce premiums and co-payments, according to Kaiser.

Mango said he would have sought the ACA exchange “state innovation” waiver, which would essentially let states operate outside of key requirements of the health care law, including the employer and individual mandates, premium tax credits and cost-sharing subsidies.

Mango in 2007 co-authored a report for McKinsey & Co. that listed mandated insurance coverage for all not covered by a public entitlement program as a financing option for a health care system.

Beth Melena, Pennsylvania State Democratic Party deputy press secretary, criticized Mango for advocating for individual mandates before Obamacare was introduced.

“Now Paul Mango says he would have done it (Gov.) Tom Corbett's way, with a waiver program for Medicaid expansion that led to chaos, kept people with substance use disorder from getting care, and created a bureaucratic maze of red tape that made it impossible for hundreds of thousands of Pennsylvanians to get health care,” Melena wrote in an email. “Mango is flip-flopping on his support for Trumpcare, and for someone who has spent his entire life as a self-proclaimed health care expert, he sure doesn't seem to know right from left.”

Mango said it was not an advocacy position but a framework provided for health ministers around the globe. He said he personally does not support insurance mandates.

“I simply think it's unconstitutional to force someone to buy a health insurance product they don't need, don't want and can't afford,” he said.

Mango did not show enthusiasm for the Republican-backed Affordable Care Act replacement plan, which U.S. House members narrowly passed in May. He described the way the bill was written as “gobbledygook.”

He said it aims to bring more people into the risk pool but fails to address fundamental issues.

“I think the intent of (AHCA) is it will bring younger people back into the market,” Mango said. “The impact though is, that just on the basis of age alone, older people would be paying a hell of a lot more. I'm not for that. I don't think it's necessary.”

Mango said the U.S. Constitution doesn't guarantee health care as a right, but he said society has an obligation to take care of fellow citizens.

“I think it's an obligation that we have as a community to take care of those folks,” he said. “But I think the obligation should be bilateral.”

As part of a social risk pool, Mango said he hopes people would feel an obligation to live healthier.

“Would you at least try to meet us halfway?” he said. “Put down the two packs of cigarettes a day, will you please.”

Kevin Zwick is a Tribune-Review staff writer. Reach him at 724-850-2856, kzwick@tribweb.com or via Twitter @kevinjzwick.