Healthcare Installment #4. Please start with post of 08/25/09.

What Makes Us Sick?


To understand healthcare requires understanding the sources of illness that lead to the need for healthcare. If you have been sick, the cause of your illness could affect your perception of how to handle healhcare. Never being seriously ill would also affect your perception. Some general reasons for illness include:


Birth defects
Genetic diseases with early, mid, or late onsets
Spontaneous illness (you just get sick, e.g., cancer)
Aging
Accidents (car, sports)
Contagious illness (tuberculosis, flu)
Unhealthy habits (eating, exercise, smoking)
　
When we examine the list, it is apparent that some causes of illness are beyond our personal control while others are under our influence if not total control. Avoiding dangerous activities (driving drunk), getting vaccinations, and eating properly are all things we can do to positively influence our health and the costs of our health care. On the other hand, being born prematurely is not a personal decision. Nonetheless, a premature infant is likely to have higher than normal health issues throughout life. Likewise, the body deteriorates with age. Things break down. We can moderate but not reverse this process.


Some of the things that interfere with good health are caused by poor lifestyle choices. Sixty percent of all American are overweight. Of that 60%, half of those qualify as obese. About 10% of all Medicare funds are paid due to obesity-related problems. With limited exceptions for diseases, this situation is one of a person’s own making. It leads to increased health problems (e.g., diabetes) and increased healthcare costs. Smoking is a similar issue, although nicotine deserves special treatment as an addictive substance. Despite continued warnings for decades that "smoking bad for your health" and its links to heart disease and cancer, people still smoke. Even the threat of death is not enough to convince 43 million Americans to stop. The good news? The percentage of smokers is half of what it was 50 years ago. This is evidence that we can become a nation of properly proportioned, nonsmokers. It is costing us too much not to be.


The cheapest way to reduce healthcare costs is to eliminate the need for the care itself through healthier living. There are no secrets here, simply better diet and exercise and decreased nicotine and illegal drug usage. This is not something the government can do for us. We must do it for ourselves. We want the freedom to choose what we eat and do. That is fine, but along with it comes the responsibility to make wise choices. Any "right" to healthcare brings with it the responsibility for personal health management. This is not to suggest that every aspect of our personal health is directly controllable since genetics, accidents, and contagious diseases all are beyond our control. Even with an emphasis on personal health responsibility, monitoring individual efforts in that regard would be highly impractical. This gives rise to the call for taxing alcohol, tobacco, and now "junk food." There is nothing wrong with creating disincentives for bad behavior, but rewards for good behavior have a stronger influence. Once again, the tax code is being highjacked to promote social policy. The use of a "Twinkie® Tax" as a systemic attempt to promote self-control will generate another interesting debate.


Compassionate Care


Really sick people don’t work and without free care, they have no care. Then there are the poor who, due to limited abilities, accidents, disease, poor choices, or other reasons have barely enough income to buy food and housing. Food and shelter come before healthcare. If the income is very limited, healthcare is missing. "The poor will always be with us" and the question becomes "How much healthcare is a nation willing and able to give to them?"


Given that health issues are both controllable and uncontrollable, it hardly seems fair to deny care to someone who is unable to provide for himself when the cause is outside his control. That is compassion. On the other hand, should people who manage their health be paying for people who do not? Probably not.


Unfortunately, there seems to be little good way to separate the deserving from the undeserving. The fit pay for the unfit. Perhaps if each person had an allowance of "healthcare credits" then those who stayed fit would build a surplus they could use for other purposes and those who went over their allowances would have to cough up the payment difference themselves (assuming they could.) Fit people might be able to sell their "healthcare credits" to those needing them and thereby profit from a healthy lifestyle. This is an idea not unlike trading pollution control credits in industry.


Persons advocating universal coverage may do so out of compassion, because they lack any affordable coverage themselves, because of personal beliefs in healthcare equality, or for other reasons. Persons resisting universal coverage probably do so because of a reluctance to pay more to provide it or because of a belief that each person should earn what he or she receives. To some extent, a lack of healthcare is an incentive to improve lifestyle and develop skills that lead to employment with better benefits. On the other hand, disease is no respector of effort and "deserving" people suffer through no fault of their own. Compassion and economics intersect badly in healthcare.