Michael

Research has shown that over 80% of an individual person’s healthcare status is outside the control of access to the healthcare system and providers – it’s how we eat, whether or not we’re active, do we smoke, do we drink alcohol and abuse drugs, the habits we develop, socioeconomic factors, etc., along with of course genetics

There’s no question that those who are fortunate to have jobs, access to educational opportunities, and above-poverty incomes have advantages those in poverty do not. But putting our heads in the sand about personal responsibility is not the answer. Yes, it’s not about blame – but it is indeed about teaching people the consequences of choice, and helping create incentives to make better choices.

We are so worried about telling kids they are overweight for fear of shaming them or making them feel bad, so when someone does make fun of them, we pat them on the head and give them a Twinkie to make them feel better. It’s a little bit by our society’s tendency to quit keeping score at kids athletic events because we don’t want to hurt their feelings, so we hand out “participation trophies” and instill in them a sense of false confidence that they’ve never earned. No question, there’s a balance to be struck, but again, ignoring the consequences of individual choice, and not helping adults and children make better choices, is wrong-headed.

Auto insurance is an adequate example – if I get in a lot of accidents or speeding tickets because of my reckless behavior, it’s not that I can’t get insurance – it’s that my behavior is associated with higher costs, therefore I’m expected to contribute more into the system and my premiums go up.

We don’t do that in healthcare. We in essence argue, it’s everyone else’s fault, not mine. After all, it’s a free society, so who are you to tell me I can’t eat a high fat and high sugar diet, or smoke legal tobacco products, or abuse legal alcohol products. But then we rationalize that it’s some how the healthcare system’s responsibility to fix these train-wrecks, and we spend an awful lot of money chasing the proverbial horse out of the barn instead of building a better barn.

We need to marry payment systems with provider incentives to focus on education and prevention, with individual accountability and consequences for poor choices – teach all of us how to adopt a more healthy lifestyle, instead of sitting around pointing fingers at the “causes” of this mess. Let’s build a true “healthcare” system instead of remaining mired in this “sick-care” system.

1. You equate “personal responsibility” with blame. I don’t equate the two. But it requires someone without resources (say) to have a support system to get to the point to take ownership or personal responsibility for their lifestyle and access habits. Ultimately it is a personal choice once one can connect wellness as a means to their life goals.

2. Under “Risk”: Well, of course lightning can come out of the sky and hit me, but if I live a healthy lifestyle and access the healthcare system appropriately, my chances of becoming chronically ill plummet, and chronic illness drives over 75% of our healthcare costs. I don’t buy this part of your thesis.

Ultimately, however, we can’t beat them into wellness, nor “make” them well. There I agree.

3. The ultimate solution is a population health family approach using community resources such as school, church, etc., and making it family-centric.