The medical delivery system is under pressure to provide quality health care despite these dire trends:
- reduced access because of the closing of community hospitals and low-cost clinics,
- staggering increases in the cost of drugs, medical treatment and insurance,
- an increasing reluctance of HMO’s to refer patients to specialists, and
- a dramatic increase in the number of uninsured, now estimated at 50 million and growing.
I could also mention the loss of physicians who are retiring because they can no longer afford malpractice insurance as well as the decline of the number of malpractice insurance carriers. Or I could note the number of individuals trapped in jobs or unable to start their own business because of the fear of losing medical coverage. Or the uninsured or underinsured families who are only one major illness away from bankruptcy. Nor did I mention seniors who are cutting medicine dosages in half to make prescriptions last longer, or who are forced to choose between groceries and life-sustaining medicine.
Experts are thwarted in their efforts to bring about reforms in the medical care delivery system by three ideas. The ideas and their implications follow (FIT):
F: Free us from the food police and others who would penalize us for lifestyle choices. Like the right to bear arms, individual choice is as American as apple pie and baseball. Overthrow the diet dictators so we can preserve the right to choose what, when, where and how much we eat and drink. We don’t need report cards on our kids’ weight either.
Lifestyle choices have financial consequences. Of the trillions spent each year on health care, an estimated 70 percent is the result of medical conditions associated with poor eating habits and lack of exercise. Financial necessity dictates that health educators and policymakers experiment find ways to influence our behavior, such as taxing soft drinks or increasing insurance premiums for overweight members.
Another approach involves educating consumers on the content of food. The assumption is that once informed, consumers will make healthier choices and reduce the risk of medical complications associated with being overweight.
Using this approach, the city of New York pioneered a requirement that restaurants post the caloric content of food. At the time it was introduced, health officials estimated that 150,000 fewer New Yorkers would become obese and 30,000 will avoid getting diabetes in five years. California and other states followed suit.
Caloric information gives citizens useful information, just as road signs make driving safer. But just as the driver still determines the route and destination, the customer still enjoys the freedom of choice.
I: Indulge today and fix the medical condition tomorrow. Using advanced technology and drugs, modern medicine can take care of whatever damage I inflict to my body over time.
Despite medical advances, treatments to reverse chronic conditions are limited. By the time symptoms appear from long term chronic illnesses, considerable damage has occurred. Treatments may slow the progression of the condition, minimize the symptoms or halt further damage, but treatments cannot turn back the clock. Nor can doctors eliminate the suffering or premature death that may result from chronic medical problems. And whether a person is insured, underinsured or uninsured, chronic conditions eat away at savings, forcing some into bankruptcy. Health is wealth takes on added meaning.
T: Total the cost of medical expenses resulting from my poor eating and lifestyle habits and send the bill to my employer or taxpayers.
Living the good life and then shifting the cost of medical care to employers or the government is a dicey proposition. Employers are struggling to absorb rising premiums: the annual cost to insure a family of four in 2012 will reach $20,000. Rather than risk competitiveness in the marketplace, employers may reduce benefits or eliminate medical insurance altogether. According to some experts, employer-based insurance programs are likely to unravel in the future, leaving hundreds of employees uninsured.
As a result of the economic downturn, governments, like families, are facing their own funding crises. Many are facing huge deficits that are likely to grow even larger. An increase in taxes is always a hard sell to voters and will be especially so in this environment. Consequently, individuals and families may have difficulty finding public sources to fund medical costs.
Taken together, these beliefs tempt us to believe that scarcity of funding is the problem. If only our government had trillions of dollars to fund medical expenses, we could enjoy good health. But even if we had unlimited funds to cover the rising costs of medical care, our citizens would not enjoy good health, simply because medical care expenses are incurred after diseases have struck.
What we need is health care that keeps us from requiring medical care in the first place. We need programs that keep us out of hospitals and doctors' offices and make prescription drugs unnecessary.
Today, the lion’s share of funding is used for medical expenses that are incurred after illness has struck. This is the equivalent of closing the door after the horse is out of the barn. Rather than building elaborate structures to contain the escaped horse, why not close the barn door?
For example, the person who has accumulated surplus pounds is at risk for a number of life-threatening illnesses and diseases, such as stroke, diabetes, cardiovascular diseases, certain cancers and gall bladder disease. This is true whether the person is insured, underinsured or uninsured. Health will elude this person until healthful habits are adopted, and no amount of funding can compensate for the absence of personal responsibility in the care and maintenance of our bodies.
Discussions about where to assign the costs of medical care are far less fruitful than discussions about how to create effective health care programs that prevent disease and the development of chronic conditions in the first place.
Much is being said and written about the medical care crisis. Criticism of various social experiments to alter our behavior will trigger strong reactions. Arkansas, for example, pulled back on its use of obesity report cards due to negative feedback from parents. Others warn us about nationalizing medical care. One often-expressed view: “If you think medical care in this country is expensive now, wait until it’s free!” Others will raise the frightening prospect of rationed medical care.
No doubt our nation will muddle through this predicament as we’ve muddled through others in the past. As we work toward a solution, however, theoretical discussions, such as this one, will be cold comfort to individuals caught in the medical crisis.
While we wait for a shift in the national mindset that, of necessity, must lead to innovative programs, we can still act in our own sphere of influence. Each of us can adopt habits that promote good health throughout our lives. This strategy is implicit in Dr. Albert Schweitzer’s observation: “Every patient carries her or his own doctor inside.” Maybe the best aspect of Dr. Schweitzer’s idea is that there’s never a wait because the doctor is always in and the service is free.
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