I dreamt last night that we had started a national war against our own ill health, in addition to the war on terrorism. In my dream the White House decision to start the war on ill health went like this:

Secretary of Health and Wellness (SecHel&Wel): “Mr. President, we have received word that the terrorist group al-Qaida is being assisted in its efforts to crush our way of life by an insidious conspiracy in America called Il-Helthi, a conspiracy that is killing a million Americans a year. We are proposing a war against Il-Helthi on all fronts.”

The President: “My God, Mr. SecHel&Wel, that’s appalling. A million deaths a year? Tell me about this evil conspiracy Il-Helthi.”

SecHel&Wel: “Well, sir, our sources tell us that a million Americans a year are being killed before their time by preventable causes, such as heart disease, diabetes, complications of smoking and obesity, traffic deaths, cancer, murder, stroke and just being poor. That’s about 3,000 casualties per day, most related to the evil axis of obesity, smoking and lack of exercise.”

The President: “Ah hah! Another Axis of Evil is behind Il-Helthi! We must do obviously do everything in our power to save our way of life from our way of life. What is our plan?”

SecHel&Wel: “We are proposing a Department of Waistland Security to coordinate defenses of our waistlines by involved branches of government. In the first phase of the attack we must disrupt the unholy alliance between high-calorie, high-fat, fast foods and the sedentary lifestyle of our people, or we cannot defeat Il-Helthi. Among other targets will be the fast food industry’s menus of high- calorie madness.”

Mr. President: “Brilliant! But what are all of those people in the fast food industry going to do for work?”

SecHel&Wel: “The Department of Waistland Security will employ them as our nation’s corps of personal fitness trainers.”

President: “More brilliant. What else do you suggest?”

SecHel&Wel: “Well, the next idea is really radical, but if we don’t think outside the medicine cabinet we are not going to win this war against Il-Helthi. We suggest that you scrap the recently passed tax break for the wealthy in favor of a tax break for the healthy. We all know the tax break plus the war on terrorism is causing us a national financial hernia anyway.”

Mr. President: “Aaackkk!”

SecHel&Wel: “Before you hack up a presidential lung let me explain how that would work, sir. We could ‘incentivize’ Americans so the healthier you get as a citizen – weight closer to ideal target, cholesterol closer to goal, blood pressure to target, quit smoking, etc. – the more of a break you would get on your taxes. Get your flu shot, get a tax break. Get your pap smear, get a tax break. Get caught without your seat belt, lose a tax break. All documented, of course, through your physician and your health insurance records, etc. What do you think, Mr. President.”

The President: “Are you crazy? A tax break for being healthy? I cannot win a presidential campaign based on support of the healthy! There aren’t enough of them – only one-third of Americans exercise regularly. I need the support of the wealthy.”

SecHel&Wel: “Well, sir, maybe if Americans were all healthier we would not have to spend an average of about $4,000 per person per year on health care. Fighting Il-Helthi makes us healthier and saves us money, and if you have to spend less of your money on your health that is like getting a tax break. Besides, the taxpayers are the biggest source of health insurance in America, through Medicare and Medicaid, so if we save money on health care because we are all healthier we save taxpayer money we might be able to use for a tax break.”

The President: “Hmmmm – or for that $87 billion we need to spend on rebuilding Iraq. OK, I’ll consider the tax break for the healthy, but the unhealthy wealthy are going to have a snit about this. Will there be additional casualties?”

SecHel&Wel: “Yes, sir – we are going to suggest that Americans shoot their televisions and exercise instead of watching TV, as part of our Sweat for Your America campaign.”

The President: “Shoot their TV’s, eh? I guess that’s OK – Americans have always had the right to shoot things that threaten their health in their homes. Maybe they could exercise while they watch instead. What else are you suggesting? I don’t hear any suggestions that would involve our biggest weapons.”

SecHel&Wel: “Well, sir, we are suggesting that we go with a couple of our weapons of mass improvement – universal insurance and a prescription drug benefit for Medicare recipients. Studies have shown again and again that as we age health insurance is the key to access to good health care, and that those without health insurance are often less healthy and cost us more to take care of in the long term.”

The President: “Universal insurance and a Medicare prescription drug benefit? Good God, man, those will be expensive! Don’t you know it goes against the American grain to invest in our health? The next thing I know you will be telling me the war against Il-Helthi is going to mean I have to eat less Texas beef!”

SecHel&Wel: “Ah … well, sir, let’s just say that from now on you are going to be eating a lot more fruit and fiber and a lot less off the hoof. You are going to have to lead us by dietary example, to be the Commander in Chef, as it were.”

Mr. President: “This war against Il-Helthi is going to kill me. All right, call together the War Cabinet and let’s initiate the campaign against Il-Helthi. The longer we wait the more we weigh.”

Then I woke up from my dream for another day of a reality that is a bit of a nightmare.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.