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

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