Uncategorized

You’re Sick. I’m Not. Too Bad.

There’s a popular, partly true, some­times useful and very dan­gerous notion that we can control our health. Maybe even fend off cancer.

I like the idea that we can make smart choices, eat sen­sible amounts of whole foods and not the wrong foods, exercise, not smoke, maintain balance (whatever that means in 2010) and in doing so, be respon­sible for our health. Check, plus.

It’s an attractive concept, really, that we can determine our medical cir­cum­stances by informed deci­sions and a vital lifestyle. It appeals to the well — that we’re OK, on the other side, doing some­thing right.

There is order in the world. God exists. etc.

Very appealing. There’s utility in this outlook, besides. To the extent that we can influence our well-being and lessen the like­lihood of some dis­eases, of course we can!  and should adjust our lack-of-dieting, drinking, smoking, arms firing, boxing and whatever else dam­aging it is that we do to ourselves.

I’m all for people adjusting their behavior and knowing they’re accountable for the con­se­quences. And I’m not keen on a victim’s men­tality for those who are ill.

So far so good –

Last summer former Whole Foods CEO John Mackey offered an unsym­pa­thetic op-ed in The Wall Street Journal on the subject of health care reform. He pro­vides the “correct” i.e. unedited version in the CEO’s blog:

“Many pro­moters of health care reform believe that people have an intrinsic ethical right to health care… While all of us can empathize with those who are sick, how can we say that all people have any more of an intrinsic right to health care than they have an intrinsic right to food, clothing, owning their own homes, a car or a per­sonal computer? …

“Rather than increase gov­ern­mental spending and control, what we need to do is address the root causes of disease and poor health.  This begins with the real­ization that every American adult is respon­sible for their own health.  Unfortunately many of our health care problems are self-inflicted…

Now, here’s the rub. While all of us can empathize, not everyone does. And few cit­izens go to medical school. Some, une­d­u­cated or mis­in­formed, might sin­cerely believe that ill­nesses are deserved.

So let’s set some facts straight on real illness and would-be unin­surable people like me:

Most people who are sick — with leukemia, dia­betes, osteo­ge­nesis imper­fecta, heart disease, mul­tiple scle­rosis, sco­l­iosis, glycogen storage disease Type II, depression, Lou Gehrig’s disease, sickle cell anemia, rheumatoid arthritis or what have you — are not ill by choice. They didn’t make bad deci­sions or do any­thing worse, on average, than people who are healthy.

Rather, they became ill. Just like that.

The idea of an insurance pool is that when everyone in the com­munity par­tic­i­pates, whoever ends up with large medical expenses is covered, explained Jonathan Cohn. When con­tri­bu­tions come in from all, including those who are healthy, funds are suf­fi­cient to provide for the sick among us.

As things stand, the insurance industry divides us into likely prof­itable and unprof­itable seg­ments. “So you know if you’re one of the people born with dia­betes, you have cancer, you had an injury that requires lengthy reha­bil­i­tation, tough luck, you’re going to end up in that pool of unhealthy people,” Cohn said.

Insurance is no cure-all, to be sure. It won’t take away my cousin’s cancer or fix Bill Clinton’s heart. That would require research and better medicines.

Depriving insurance, or care, to those who need it most is incon­ceivable to a society as ours was intended. It’s uncivil.

Elaine Schattner MD is an  trained oncol­ogist, edu­cator and jour­nalist who writes about med­icine. She teaches at Weill Cornell Medical College.  You’ll find her blog, where this post first appeared, at Medicallessons.net

Livongo’s Post Ad Banner 728*90

Categories: Uncategorized

41
Leave a Reply

41 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
18 Comment authors
keiko deeMark CohenSteveHGary LampmanMargalit Gur-Arie Recent comment authors
newest oldest most voted
keiko dee
Guest

Cupertino dentists

Mark Cohen
Guest

Good article! I believe that most of the cases that doctors see are cases that have to do with preventable root causes, such as heart disease, blood pressure, etc. However, there are a wide array of health problems that are not behavior-related. Overall, because most of the cases are preventable by patients, I think a major emphasis should be placed by doctors on preventable care, rather than just prescribing drugs and treatment repeatedly. I think that a lot of the cost incurred by the patient is due to not focusing on the root causes of illness. Clearly, the patient must… Read more »

SteveH
Guest
SteveH

Perhaps it’s an innate human desire to believe that we are all in control of our destinies, but I think there’s something peculiarly American about this. That’s one reason some were so strongly against Health Care Reform that would expand the number of the insured: You are responsible for your own health and if you got sick it’s your fault. You were fat, you ate the wrong things, you smoked… it was something you did to yourself so why should the rest of us help you out? It’s not just diseases that are sometimes (but not always) related to lifestyle,… Read more »

Margalit Gur-Arie
Guest

I don’t know about the machines, Nate, but I was reading a report about medical innovation from PwC and there is one graph on page 10 showing the cost of a hospital bed per day and it is mind boggling
http://pwchealth.com/cgi-local/hregister.cgi?link=reg/innovation-scorecard.pdf
(you may need to register, but it’s free)

nate
Guest
nate

not sure about this data Margalit, it says actual payment but if I have one claim out of 1,000 that is out of network and I get stuck paying full price is that where the 95th percentile comes from? The spread between low, average, and 95th percentile doesn’t make any sense. Thank you for the link though it is interesting. One other question I have is I think I recall reading that our imageing is of much higher quality then that a lot of other nations use. I hav also heard that extra quaility/detail has little to no value but… Read more »

Margalit Gur-Arie
Guest
DeterminedMD
Guest
DeterminedMD

Two comments I know to be true, the first is an absolute, and the second a fair generality, and if commenters can come down to this point in the blog to read this thread, I hope they will echo, or perhaps debate: 1. The costs of health care are driven by all parties involved in the process, that being patients, physicians, insurers, pharma and medical device companies, state and federal agencies of oversight, other providers outside physicians, families and significant others of patients, and others who are minority in percentage but count in the end. 2. Responsible and accountable physicians… Read more »

Gary Lampman
Guest
Gary Lampman

Determine MD To answer your question is, not really. Patients do have some responsibility. I guess you would say malpractice and defensive medicine is our responsibility that drives up cost.However, if we eliminated these excuses Im sure their will be other excuses. Look, your being sponged off from Medical Malpractice insurance and do you dictate premiums. No not at all. Insurance drives up premiums and tells you what to pay and how to protect yourself from Law suites by ordering a battery of tests. Each Health Insurer permits you to choose specific coding to maximize returns. Doctors not only push… Read more »

DeterminedMD
Guest
DeterminedMD

“When the Patient becomes a active participant in these contracts .Then and only then can you blame the costs of Health Care on them! Until then ,you will have to stop lying to yourselves as who is responsible. It rest soley between insurers and providers!” You have got to be kidding me!? All patients have nothing of responsibility or accountability to the role of escalating health care costs? This is why I continue to be astounded by the sheer audacity and cluelessness behind these attacks on providers. There has to be someone to lynched for the problems of our society,… Read more »

Gary Lampman
Guest
Gary Lampman

Your sick I’m not to bad. Your sick,can’t buy access to bad so sad. The GOP’s perception is if your sick and going to die. Die Quickly! This a throw away generation that implies and infers that once you have out lived your usefulness.You should be kicked to the curb and put down. Insurance is a market of death panels for self profit.A interfering force that has been designed to push self serving Greed and profit margins at the expense of their subscribers. Insurance aligns its self with contracts that promote their selves and exploits the poplulation. The same is… Read more »

Barry Carol
Guest
Barry Carol

Nate – The Health Affairs paper on the Swiss healthcare system last summer included comments about much higher prices paid here vs. there for just about everything. Also, Uwe Reinhardt at Princeton published a paper, also in Health Affairs in 2003, I believe, titled “It’s The Prices, Stupid.” I think you can access an abstract of the article through Google but a subscription to Health Affairs is needed to read the whole thing, unfortunately. Our utilization of major procedures is not that different than in other countries. Some other countries actually consume more drugs than we do. Our utilization is… Read more »

nate
Guest
nate

“the answer is that every dollar we spend here is buying less than a comparable dollar buys in Switzerland, for example.”
Do you have anything to support this? The studies I have seen said our per unit cost is not higher then most other countries. Rx is the big exception here on Brand name drugs, Genric we are substantially cheaper.
Our utilization/consumption on the other hand blows them away.

Peter
Guest
Peter

“No Peter that is how Obama saves his friends and contributors money by giving them exemptions so they can cap it at $50,000 or less.” Nate, from this examination Republicans seem to be doing very well also. What right-wing-rant show are you getting your info from? http://northshorejournal.org/examining-the-111-exemptions-from-health-care-reform But this is only a 1 year waiver. “Now that you know its your god Obama doing what do you think of it?” I no longer support Obama after he caved in to Republicans on the Bush Tax cuts and threw in a reduction to the inheritance tax AND reduced payroll deductions as… Read more »

Margalit Gur-Arie
Guest

Jumping in a bit late, but I think Barry has hit the nail on the head. We keep arguing about HOW to pay for health care, but we need to discuss HOW MUCH we pay for health care. You can slice and dice various pools and coverages, but those are questions of equitable distribution of resources, or lack thereof. The big question in my mind is what do our resources buy us, and the answer is that every dollar we spend here is buying less than a comparable dollar buys in Switzerland, for example. We need figure out why and… Read more »

nate
Guest
nate

“but obviously you’d pay more for annual $50k max over unlimited” Actually Peter a plan with unlimited max is considerably more expensive then one with a $50,000 limit, obviously. You said the people Obama has given exceptions to are still paying into the pool, but they are paying into it at such a minimial level they are not contributing like you claim everyone should. ” Is that how you save your clients money Nate” No Peter that is how Obama saves his friends and contributors money by giving them exemptions so they can cap it at $50,000 or less. Now… Read more »