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POLICY: Millenson, not too impressed by Hucakbee’s diet mania

He may be out of the White House race by next Tuesday night, but Michael Millenson is interested but not convinced about the values of Gov Mike Huckabee as he promotes self-relicance in health care. Michael is writing at the Health Affairs blog

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  1. I doubt anyone would argue against personal responsibility and self-maintained wellness, but motivating consumers to live healthy lifestyles is a complex matter involving many psychological and cultural factors, which explain why more “skin in the game” is no solution.
    In fact, the U.S. Department of Labor has decided to curtail the ability of employers to motivate workers to kick unhealthy habits by making health insurance more expensive for unhealthy workers than for their colleagues, as reported in a recent Wall Street Journal article–Wellness Programs May Face Legal Tests: Plans That Penalize Unhealthy Workers Could Get Tighter Rules.
    At this link, I discuss how wellness programs focused on healthy living are one key ingredient for healthcare cost control. After all, healthier people tend to be happier, more motivated and more focused, which not only gives them a better quality of life and reduces sick-care expenditures, but also benefit their employers through reduced healthcare-related costs, improved productivity, lowered absenteeism and fewer on-the-job accidents.
    I go on to explain why using “sticks and carrots” in such wellness programs can help convince some employees to lead healthier lifesytles, but they will be ineffective or even harmful for some due to powerful psychological, physiological and situational factors.
    What’s needed, therefore, is greater investment in wellness coaching/counseling through wellness/prevention programs for those with serious risk factors and those struggling with self-maintenance of chronic conditions.

  2. Claudia – I think there is agreement on the fact that the “system” is incredibly broken. What I know I react to is the idea that people don’t play a role in their own health and therefore the expenses they will incur in the health system. No it’s not 1:1, but the fact that in a government funded health program you are asking me to fund the care of those around me, I would like to see some recognition that some health expenses are driven by personal behavior. Yes joggers have heart attacks, but I am sure that the number of overweight people with diabetes is higher. And of course smoking is addictive behavior, but it still comes down to individual choice. You lose me when you imply that people are helpless in the face of compulsions and addictions. And yes other countries have addressed the important social policy of health, but this is America and it’s 2008. Our understanding of health is greater, and our culture has developed in its own uniquely American way, with our own expectations about personal responsibility. We need to address health policy, but it can’t be in a way that allows people to do whatever they want and expect other people to pay for the consequences.

  3. Of course broccoli and jogging are good, all else equal. But in American health care, all else is not equal. The financial structure of the system is broken, and no amount of broccoli will fix it. Insisting on it is wishful thinking and would force one to make the argument that the rest of the developed world, whose health systems work much better than ours, as virtually every single indicator shows, eats an awful amount of broccoli.
    When the UK, or Canada, or even Otto Von Bismark in Germany in the late 1800s, decided that social insurance was the best way to finance health care, they were not opposing healthy lifestyles and broccoli, but rather taking policy seriously.
    Claiming that Americans’ lifestyles are the root of the problem, however well-intentioned preaching the healthy lifestyle gospel might be, is just not going to fix our health care problems.

  4. Why is “eat your broccoli and jog” nonsense? If you choose to eat junk and cause yourself chronic health problems, don’t expect others to pay for your meds.

  5. Right. People can’t help it if they eat too much unhealthy food, exercise too little, smoke, drink to excess. It’s just too much to expect for people to take responsibility for their own actions, and addiction itself is a disease that is out of an individuals control. And of course those things aren’t really related to health anyway. Next thing you know you’ll be saying second hand smoke is dangerous!
    I’m not saying we don’t need compassion and I’m not suggesting we don’t need to pursue some kind of strategies that get more people the healthcare they need, but we also need to hold people accountable and give them incentives to live healthier lives.

  6. Congrat! This is the best reply to the Huckabee “eat-your-broccoli-and-jog” nonsense as the key strategy to resolve the American health care mess I have read in the last few years! Every single presidential candidate should read it! I’m afraid virtually all of them (exception, Kucinich) share the same mindless assumptions…

  7. “Woolf then goes on to highlight the harmful health consequences of increasing poverty rates, decreasing household incomes and widening income inequality. This uncomfortable topic goes unmentioned not only by Huckabee, but by all the Republican candidates, who are too busy heralding the power of the “consumer” to notice what happens when the consumer has no power at all. The evidence suggests strongly that economic disparities explain why Arkansas ranked forty-eighth of fifty states in the number of premature deaths (before age 75) that could have been avoided, avoidable hospital use and similar quality measures. And what about the health impact of tax cuts that starve public schools of revenue and drive them to a market-based trade-off of access to their students’ bodies in return for payments from the companies making sweetened soft drinks and salty snack foods?”
    The South was the China before there was a China. It had/has a largely poor, rural and ignorant population that southern politicians could easily sell/exploit to northern corporations looking for their next cheap labor pool and cheap land/construction costs. This was fueled by tax policies and give-aways in conjuction with union busting legislation (right to work) that has worked against southern citizens in the long run. Southerners haven’t figured this out yet and when you look at the decline in the northern industrial cities you will realize their battle at revitalization is largely lost because of this and because winter is hell to retire in.
    The ignorant are easy pray for prayer and the idea that hope is about your faith, not about the conditions, policies and powerful that keep you poor.

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