Thursday, March 20, 2014

Thinking About Healthcare in America and Personal Responsibility

The other night I was out to dinner with a group which happened to include an old friend I had not seen in about 15 years. Let's call him Zoltan (I always wanted to know someone names Zoltan). Last time I saw Zoltan he was maybe just out of college, lean, and very active. Zoltan had been a member of the health club I owned at the time - Body Dynamics. Today, my old friend is a much different person than the last time we spoke.

The person I had dinner with is married with a child, working a white collar sales job, and would never be confused with an athlete. To use a word this person is frumpy. During the conversation among the group Zoltan said flat out that exercise used to make him feel good ... but now, eh, who wants to get off the couch.

I bring this up because, during the two hour conversation among us, we ended up talking about the Affordable Care Act (aka Obamacare), the health care system in America, health, and of course how I'm that "crazy" triathlete who eats healthy. On my way home that night I became more agitated by the whole thing. Here's why:

There were a number of people who were outright complaining about Obamacare and how it is "destroying" healthcare in America. Costs are exploding; people are losing their coverage; all the talking points we have all heard ad nausium for years. I asked if anyone knew of someone who lost coverage and the answer was no. I explained that my business has saved money this year due to the implementation of the ACA. Zoltan, looking surprised, claimed to have never heard that from anyone. More shock when I explained that a policy for The Queen and I today through the exchange would cost less than I paid 17 years ago. I then went on to explain how the Obamacare "horror stories" have all turned out to be false. Again, looks of surprise.

From there the conversation turned to the cost of healthcare. Long story short, what most everyone at that table couldn't understand can be summed up in this infographic:


Moving on, Zoltan starts talking about his own health situation and how he is glad he sees a doctor on a regular basis. He's glad because he was diagnosed with type 2 diabetes, which he says is something he is genetically susceptible to having. He is currently on medication, which I assumed are statins from one of the major drug manufactures. His doctor did say that if he lost weight and exercised he could once again live without the prescription medication (I give huge props to his doctor for even bringing up the fact that a simple lifestyle change could make all the difference in not just managing the problem, but eliminating it). And if you didn't figure this out already, Zoltan is in his mid-to late-30s.

So here's what bothers me about the entire situation. I sit through a good 20 minutes of listening to people bash the changes to the health INSURANCE system (Obamacare) and complain about all the problems with it, giving no solutions, of course, with concern for only what it would cost them in the long run. What was failed to be understood is the why we have such high costs. Yes, we pay more than other developed nations for the services we are provided. Yes, we have an aging population which will need more care in the years to come.

But ... and this is important ... what was NOT mentioned by anyone, was the cost of many not taking personal responsibility for their health. 

Wait. What?

See, my friend Zoltan was very straight up in admitting that he is overweight and doesn't exercise. He was also straight up about the fact that his doctor told him that, if he did both, he would not have to take drugs. Yet, he wasn't doing either. Instead, he was basically going on with life as it was before he found out that he had a health issue, taking the medication he was prescribed, inevitably paying whatever the co-pay is for said drug.

Which would be perfectly fine with me ... really it would be ... after all we have personal freedoms, right? I can do to my body whatever I want to for the simple fact that it is my body. Except ...

Except for the fact that we, as a society, through the health insurance system, bare the cost of those personal lifestyle choices. 

As a healthy 44 year old who takes the time and effort to eat healthy, exercise, not smoke, and generally not take stupid risks with my health, this lack of personal responsibility is sooooooooo not right in my eyes. And there are many people just like me. You can see many of them running or biking on the side of the road. Or maybe you make fun of them at work because they ate a salad for lunch instead of Taco Bell. You may see them at the gym or yoga class, but it is likely you are one of them (us). And by us I mean those who take the personal responsibility for our health.

While these numbers aren't as current as I would like, I think it's safe to say that the situation hasn't gotten better in the last eight years:

"Several investigators have evaluated the cost of obesity on an individual level. Finkelstein and colleagues found that in 2006, per capita medical spending for obese individuals was an additional $1,429 (42 percent higher) compared to individuals of normal weight. (7) Cawley and Meyerhoefer, meanwhile, found that per capita medical spending was $2,741 higher for obese individuals than for individuals who were not obese—a 150 percent increase. (1)
Thompson and colleagues concluded that, over the course of a lifetime, per-person costs for obesity were similar to those for smoking. (10) In middle-age men, treatment of five common obesity-related conditions (stroke, coronary artery disease, diabetes, hypertension, and elevated cholesterol) resulted in roughly $9,000 to $17,000 higher costs compared to normal-weight adults."  Harvard School of Public Health
So the next time someone brings up healthcare, our healthcare system, and how much it costs, I hope you give some thought to how much better off we would be as a society if everyone took some responsibility for their personal well being. Yes, I know there are conditions out of our control (like type 2 diabetes) that I have no problem paying for with my health insurance dollars. But when it comes to paying up for care and procedures caused by the poor choice of someone who doesn't care for themselves ...

Train hard. Stay Focused.
Jon


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