There exists a growing number of credible doctors and medical research organizations who do not believe that declining health and increasing health care costs in our country are inevitable. Nor do they agree that only a massive, hyper-expensive health initiative can dampen the trend. In fact, they believe that it is mandatory that we apply current knowledge of disease prevention and health maintenance before any changes to our health care delivery can be effective.
Health news in the media today, and politicians’ pontifications, focus only on health care cost and accessibility in this country. But what U. S. citizens actually want is good health, not some particular implementation of a health care system. If the question is asked in the correct manner, the vast majority of people will say that “health” means an absence of pain or other symptom of sickness. That’s a good enough definition of what result we are expecting; it’s a place to start looking for better health care which is also accessible and affordable.
First, who should be responsible for the health of an individual? The government? The health care providers? The health insurance industry? Actually, the only answer is: none of the above! The government, the providers and the insurers each play a role, but every individual is and must be responsible for his or her health. Medical providers cannot assume responsibility for patients’ health; nor can the government, nor can the health insurers. The reason this is true is that individual choices have the greatest impact on disease prevention and health maintenance. Genetic factors and environmental factors (especially if unrecognized) beyond the control of the individual do impact health, but not nearly so much as individual choices and actions.
There are only two exceptions to the individual-responsibility truth: children and mentally challenged individuals. Parents are responsible for teaching their children the fundamentals of health and hygiene, beginning with the earliest steps such as washing hands and brushing teeth. Guardians of individuals who have limited mental capacity must similarly teach these people those health principles that they can comprehend and apply; beyond that point, health of these individuals will continue to be the responsibility of others.
But a little introspection is in order. Of course I want good health, and so do you! But is that all we are talking about when we agree that every individual must take charge? Not totally. What we all want is good personal health, plus good health for our spouses and our children, and across time good health for their families, and so on.
Second, except for assuming responsibility for one’s own health, the first and most important step forward in the quest for better health is education. I realize that this statement will cause most readers to turn elsewhere; but please humor me and read on to find out what I mean by “education”.
My personal “health education” frustrations come from attempting to learn about some newly-discovered diet, or trying to understand a serious health condition via the internet. Most diet books say either “trust me, this diet will work for you”, or they confront us with several chapters of confusing and /or boring rationalizations. Specific disease diagnosis and treatment therapy information available from the internet can be even worse; some articles appear to have medical school completion as a prerequisite for understanding the first sentence. But that’s not the kind of education I’m talking about.
All of us absolutely must know and apply the scientifically-accepted “rules of thumb” concerning disease prevention and health maintenance. These are the important health truths that civilization learned originally via long and painful trial-and-error, confirmed and understood through more recent scientific study: not enough vitamin C in the diet causes scurvy and not enough vitamin D or calcium causes rickets; untreated drinking water is the usual source for several serious diseases; food left out too long at room temperature can result in food poisoning; failing to brush our teeth regularly and observe dental hygiene leads to unnecessary loss of teeth; just washing our hands is the most effective disease prevention; and so forth. Most of us already know more than we think we know. However, we don’t always apply this knowledge routinely once we become independent adults, responsible for making our own way through life. Worse yet, when we abandon the healthy habits our families may have imposed upon us as we grew up, we are unlikely to impart those desirable traits to our children.
Part of our departure from “the healthy fold” can be attributed to pharmaceutical company end-consumer advertising (”our pill will cure whatever ails you”) which leads to unreasonable medical expectations. Another somewhat related part is the persistence of the long-discredited “binary theory” of medicine: you are either sick or you are well, nothing in the middle. Such a short-sighted view blinds us to the value and necessity of disease prevention and health maintenance.
Third, there are areas in which the government, the health care providers and the health insurance industry can be more effective in helping us to become a healthy nation.
Government does almost nothing well; but governments’ performance in one area seems to have escaped that generality. The government—federal, state and local—can be effective in educating its citizens in specific, focused areas. Look at the efforts to reduce smoking in the United States: in about 50 years adult smoking has been cut by half, and some progress has been made in reducing the number of new, younger smokers. California has been the leader in reducing the overall incidence of smoking. Another area in which both government agencies and private groups have had successful collaborations is in AIDS awareness campaigns.
The federal government, cooperating with and coordinating state and local efforts, is fully capable of implementing a world-class, full-court-press disease prevention and health maintenance (”healthy living”) initiative, at a negligible fraction of the cost of any universal health insurance or universal health care delivery system that has been visualized. Such an initiative is, in fact, a mandatory prerequisite for any universal health care or health insurance plans to be effective.
That area we sometimes forget is a part of government—public schools and colleges—could be particularly effective in integrating disease prevention and health maintenance concepts and practices into the curriculum. From preschool through university our educational system should provide the information that is essential for all students to be equipped to foster and maintain a healthy life.
However, the difficulty in prodding the government into a really effective health improvement program is the fact that politicians are extremely reluctant to vote for anything that will take longer than one or two election cycles. I guess we voters are on the hook to somehow make the politicians believe we really want better health—not just for us, but for our children, grandchildren, great-grandchildren, and beyond.
Health care providers periodically take their turn as the whipping boy du jour for both the public and for pot-stirring politicians. I am far from an apologist for the persistent problems in health care delivery, but I don’t believe the providers are really as bad as we perceive: self-indulgent, uncaring and bloated with bureaucracy. My biggest disappointment with the medical community is their passive willingness to let the politicians herd us down the wrong path toward a bleak and sparse pasture.
By and large, the health care industry is way ahead of most of us on disease prevention and health maintenance. It is true that the current shortage of doctors was identified as a future problem, and that little or nothing was done to head it off. However, it seems likely that serious, preventable problems of this nature will recur only rarely. The AMA (American Medical Association) health insurance reform initiative is another positive sign from the medical sector, although the current proposal still needs more work.
That brings us to the health insurance industry. This segment of the insurance industry is not really the greedy predator portrayed by politicians who need a scapegoat for their demagoguery. In fact, the health insurers have the largest financial stake in our being healthy: healthy people file fewer and smaller claims for doctors, clinics, hospitals and pharmacies than their less-healthy countrymen.
One fact is not widely known—even to the AMA: most families get their health insurance through the employer of a family member; and a significant percentage of all covered workers’ employers are self-insured. That is, with a self-insured company the coverage limits, exclusions and benefits defined in the policy are established and controlled by the company. Recognizable health insurance companies are usually contracted to maintain the policies and process claims for a small fee per transaction. But the money in the account from which claims are paid is supplied by the employer company. Clearly it is in the best interests of the employer, their claims processor, and their independent health insurance consultants to work very hard to provide the employees with the best bang for the buck.
Insurance companies support a growing number of “wellness” programs: education and support for those suffering from chronic diseases, such as diabetes; programs for smoking cessation; classes and physical training for weight loss and fitness, etc. Because 80% of all health care costs are due to chronic diseases, the wellness programs championed by health insurers can have a significant positive impact on both personal and national total health care costs.
Another little-known insurance industry effort is the statistical analysis of claims history to identify areas of excellence (or areas of deficiency) in the medical outcomes of patients treated at the various hospitals—diagnosis, therapy, time and cost, and resulting degree of cure or effectiveness for the patient. (Note: this initiative, demanded by the companies who purchase health insurance services, has not been well received by the medical sector. Although such studies have normally not extended down to the level of individual practitioner, they are nonetheless viewed as threatening).
Whether the health insurance is in the self-insured or underwritten category, the best business outcome for health insurers is healthy people.
Fourth, what can you and I do, right now (short of enrolling in medical school)? We can pay attention as the fire-hose stream of health information streaks by on television, on the internet, and in daily, weekly and monthly publications. Our goal is not to become experts or sink into a health obsession, but to be at least as knowledgeable about health as we are about the other common, everyday concerns.
We, the public in general, can also take action.
- Seriously review our health insurance situation: competitive costs; coverage; and options.
- If health insurance is beyond our means, locate all of the sources for free or low-cost medical care: clinics for people who are not eligible for Medicaid but who don’t make enough money for regular insurance; free health screening sessions periodically offered at various locations (e.g., shopping malls); public health departments; teaching hospitals; etc.
- Refresh our understanding of generic prescriptions; locate the most advantageous sources for medicine; and faithfully take the medicine our physicians have prescribed.
- Assure we have all of our adult vaccinations (and make sure our children have theirs).
- Actually use available health care providers for periodic (wellness) checkups.
- Seriously review our diet while redoubling our resolve to eat healthy (and do what we can to combat the junk food tidal wave that engulfs our children).
- Raise our priority for a regular aerobic exercise regimen—so that we actually will do exercise.
- If we smoke, get the necessary help to quit; if we don’t, then don’t even think of trying or starting.
- Don’t even visualize, much less do, recreational drug use—either prescription or illegal drugs.
- Avoid all types of risky behavior (including bad driving habits), and take a defensive driving refresher course.
A number of credible sources have projected a 50% to 80% reduction in national health care costs if we could somehow convince a significant number of our citizens to take those ten steps. It would be ineresting to see a projection of the total fiscal effect of having a population that is healthy, believes that it is healthy, and enjoys the benefits of good health.
Tags: disease prevention, Health, health care, health care costs, health care insurer role, health care provider role, health maintenance
