Saturday, September 12, 2009

Where's the Personal Responsibility in the Health Reform Discussion?

If every American made 4 simple lifestyle changes, 78% of the $2.1 trillion spent on healthcare last year would be unnecessary. These lifestyle changes would eliminate 91% of diabetes cases, 81% of heart attacks, 50% of strokes, and 36% of cancers. Not having to pay to treat preventable disease would leave plenty of money to subsidize coverage for low- to moderate-income folks.

These lifestyle changes are not difficult to understand or even to do for somebody who's sufficiently motivated. They are:
  • don't use tobacco
  • eat a healthy diet rich in produce, whole grains, and lean proteins
  • exercise 30 minutes per day
  • maintain a healthy weight
Sounds obvious, but fewer than 1 in 10 individuals actually manage to do all four. And that is one of the main reasons why my family had to pay $1500 for one month's worth of COBRA coverage.

Yes, genetics do play a role in body weight. We should focus more on eating healthy and exercising than the number on the scale. But while genetics might make someone 25-30 lbs. overweight, they're not going to make someone morbidly obese. That's the result of poor lifestyle choices. Genes haven't changed in the past two decades, but the percentage of the population who are morbidly obese has increased dramatically. And the rest of us are paying up the wazoo to subsidize the diseases caused by poor lifestyle choices :-(


christinemm said...

You have hit the nail on the head. This is not about asking people to take personal responsiblity. It is about a hand out.

Health ins started as a way to cover major medical expenses. HMOs shifted by focusing on wellness, covering preventative care as well as offering low co-pay's for office visits for any ailment. Even making people see their PCP before getting permission to see a specialist got people into the habit of going to the Dr. when they didn't need it.

(True story when I worked at an urgent care center ignorant patients albeit educated people would get so angry when they were not given an antibiotic when it was NOT the appropriate treatment for that diagnosis that some would refuse to pay the bill. "I got no medicine and I am sick so I am not paying!" I'd explain, "The doctor did examine you and gave you a diagnosis of X and that does not need AB!" They didn't get it.

And some were so unhappy to have even a common cold they wanted an outside expert to FIX it even when no cure existed.

A major thing with med expenses now is that Cancer treatment has come so far that it is being detected earlier and the chemo and readiation are considered outpatient services. So anyone who has chosen to only buy inpatient hospital coverage has to pay for those services out of pocket. I know this is an issue for some people who are ignorant about things like that. Then they are mad after that the coverage they chose didn't cover that service and cost them a few hundred thousand dollars.

I am also sick of this being called health care reform when the only thing being changed is health care insurance.

Andrew Bell said...

You will _probably_ be healthier if you do the things that you suggest, but you seem to misunderstand the reasons for the incredible run-up in health care costs.

Health care premiums have MORE THAN DOUBLED in the last ten years. This is unsustainable, and there is no evidence that it has been caused by some incredible run-up in illness.

The health care market does not exhibit a normal supply/demand behavior. There are many reasons for this that I won't get into. Take a listen to last weekend's "This American Life" (NPR) for some details, if you're interested.

Something needs to change. There are lots of options for reform, but it is going to happen whether we like it or not, because the current cost trajectory is unsustainable.

P.S. - The correlation of good eating, obesity or exercise with lifespan is surprisingly weak. Smoking, on the other hand, is likely to take between six and seven years off of your life.