Real Health Care Reform

We hear a great deal today about health care reform. The pundits and politicians are bantering about like hens in a hen house clucking about this plan and that reform. It is politically and philosophically prudent to be on the side of some type of change in the health care system. No one disagrees that the system is unsustainable in its present configuration. I concur that the situation is dire, the patient is in cardiac arrest and something has to be done. However, I differ from many in believing that the solution is one that is simpler yet more impractical than a government take over. I realize that sounds somewhat contradictory, simpler yet impractical, so let me explain.
We will never cure this country’s ills without a strong dose of personal responsibility. The government, politicians, insurance magnates and even doctors are not only inadequate to change the system, but incapable of effectively bringing about change, because the change has to begin from within. It has to come from the individual, the man in the mirror. The biggest healthcare crisis in this country is not cancer, AIDS, heart disease or funding, it is people not making healthy lifestyle decisions. Until we as individuals start doing the things we know to do to stay healthy, we will be a nation of sick care delivery not health care. Part of the problem is one of education. For example many feel that getting regular mammograms and doing self breast exams are excellent preventive tools for breast cancer. They are not! They are simply tools of early detection. The cancer already exists when the utility of mammograms and self breast exams is realized. These tools prevent nothing other than higher morbidity and mortality, which is a good thing. But we have to move back one level if we are to truly prevent breast cancer. For example, decreasing your body mass index (BMI) a simple measurement that assesses your amount of body fat can reduce the occurrence of breast cancer 40%! Reducing obesity, stopping smoking, increasing your intake of fruits and vegetables, limiting alcohol intake; these are behaviors that all substantially reduce the likelihood that you will develop a breast cancer. Are mammograms and self breast exams important? Of course they are. They have been shown time and time again to increase survival rates in breast cancer victims, but our focus should be not only on early detection but absolute prevention. If the government wants to have an impact on breast cancer, focus more on exercise programs and dietary instruction rather than new and expensive imaging technology. With breast cancer or any illness, it goes back to decisions and actions that an individual takes. That is not to say that someone who is thin and a vegetarian will not get breast cancer. There are multiple factors that go into disease development, many of which we don’t understand. My point is that, in general, the skinny vegetarian has a lower incidence of breast cancer than the fat, couch potato, and when you expand that to whole populations you begin to see how individual decisions can have a massive collective effect.
Another example from my field of women’s health care is cervical cancer. The PAP smear revolutionized the care and treatment of cervical cancer in the 50’s as it allowed for the detection of the disease in it earliest stages when it is 100% curable. As time went by and research progressed it became apparent that a major cause of cervical cancer is infection with the Human Papilloma Virus. PAP smears can pick up changes in the cervical cells long before they develop as a cancer, but the PAP only detects the changes once they are there. There is nothing about the PA tat prevents cervical cancer. One of the only things that does prevent infection with HPV is minimalizing sexual partners. Having multiple sexual contacts dramatically increases your risk of infection with HPV and thus greatly increases your risk of cervical dysplasia and cancer. Again, prevention is different from early detection. If you want to prevent cervical cancer, develop effective programs supporting abstinence or monogamy. How many politicians are willing to handle that hot potato?
These are but two examples illustrating that the answer to our health care crises begins and ends at home. Simply providing health insurance to everyone will only reduce the number of uninsured, a rather obvious conclusion, but it will do nothing to solve the real problem; that of preventing disease. 48 million uninsured sick folks will become 48 million insured sick folks which will further bankrupt and already bankrupt system. Each and every individual has to take responsibility for making healthy choices if we are to resolve this sick care crisis. At the beginning of this piece I stated that the answer was simple, personal responsibility. I also said it was more impractical. I am no pie in the sky optimist that expects Billy Bob to give up his PBR and Twinkies. I understand that Suzie Sweatbelly will stay hermetically sealed to her couch of doom and not exercise. My point is that what we as a society have to decide is how to convince Billy Bob and Sally that they are killing themselves and their kids by living an unhealthy lifestyle. I realize the contradiction in this line of thinking. In individual has every right to live the life they choose. I agree. I as a fellow citizen have no moral authority to tell Billy Bob that he must lose 50 pounds. He chooses his lifestyle, but he also takes responsibility for his actions. Here is where the problem arises. We clamor for personal rights but we cower from accepting personal responsibility. Do we as a society have a moral imperative to take care of the sick and affirmed, yes, but that is paralleled by a moral responsibility of the individual to make decisions that improve their health. I am my brother’s keeper, but in turn it is my brother’s responsibility to not embrace behaviors that jeopardize his health and my good will.
Will we ever be a society of both free will and moral accountability? We must if we are to survive this health crisis.