Thursday, August 20, 2009

Health Care and Personal Responsibility

Free Press columnist Brian Dickerson asked a provocative question in his column today: Do we all have the same right to health care?

What about these men he saw last weekend at the Woodward Dream Cruise?
...a trio of well-fed spectators wedged into identical lawn chairs on the public right-of-way. [...] Each held a beer in one hand and a cigarette in the other, and all three sported pendulous bellies that spilled over their beltlines and glistened in the midday sun."
Why shouldn't those men be entitled to health care? Obesity and obesity related-conditions like hypertension have been blamed for our rising health care costs, but other major factors include spending on prescription drugs and new medical technologies, longer life spans, a greater prevalence of chronic illnesses, an aging population, and high administrative costs. Poverty, stress, air pollution and environmental hazards affect our health too.

And healthy habits do not necessarily translate into lower costs (via Economix blog/NYT).
Vermonters have the healthiest behaviors, including less smoking and more exercise, according to the latest Gallup-Healthways Healthy Behavior Sub-Index numbers. [...]

The states with the unhealthiest behaviors were primarily located in the Midwest and the South; the worst were Kentucky, Arkansas, West Virginia and Indiana.

How do these healthy behaviors factor into health spending in each state? Not a whole lot, or so it appears on its face. ...

The Western states showed both healthy behavior and lower health costs, but the Northeastern states spent a lot per capita on health care despite their relatively healthy habits. Vermont, for example, spent $6,069 per person on health care in 2004, the ninth-highest level out of the 50 states and the District of Columbia.
Dickerson believes everyone should enjoy access to some minimum level of preventative and acute care, but he wants to add stipulations, i.e. "reimbursement for the cost of treating many chronic health problems should depend, at least to some extent, on what steps the patient has taken to avoid them."

I'm in favor of personal responsibility too, although I'm not sure how possible it is to accurately measure a person's efforts. And in the case of drinking, smoking and overeating, there are often underlying emotional and psychological problems that make quitting extremely difficult. Is it fair to penalize them for falling off the wagon?

Fortunately, helping people live healthier lives is being addressed by President Obama whose principles for health reform include prevention and wellness initiatives. They're also included in the Senate HELP Committee and House Tri-Committee plans. (See a side-by-side comparison of all plans here.)

We need to get health care reform passed and make available to Americans the tools and information they need to live healthier lives today. Nitpicking about personal responsibility and unhealthy habits only serves to slow down or sink reform.

(Cross-posted at Blogging for MI.)


K. said...

It's a red herring anyway, as if there were some correlation between having health insurance and a healthy lifestyle.

Today, these gentlemen are exactly who we pay for when we pay health insurance premiums. Some sort of universal coverage so that payments are amortized across the entire population and tilted toward the unhealthy -- are the only way to bring premiums down and bring overall costs under control.

Courtney said...

Great post - I completely agree! A person can maintain a perfect weight, not smoke, and then get hit by a bus and need long-term care. Getting boggled down in "personal responsibility" is an argument, I think, once health care reform has passed, not before. It's somewhat similar to why I get frustrated with the abortion argument...let's worry about stopping ALL violence, physical and sexual, against women - once that problem has been solved abortion might be a relevent discussion. Until then I don't think it is.

Kathy said...

K, the uninsured don't normally see a doctor until they end up seriously ill. Universal coverage will make it easier for people to visit their doctor on a regular basis, which in turn will increase the likelihood they'll receive the encouragement to live healthier lifestyles.

Courtney, the irrelevant stuff being dragged into the health care reform discussion is very frustrating, and this discussion has been going on for 60+ years now! It's time to pass reform and worry about tweaking it later.