In "Can We Still Afford to Cheat Death", I wrote off of her comment:
Fifty percent of health-care costs are incurred in the last month of life and those costs rarely change the outcome of the patient’s illness.But immediately after this, she went on to say:
In addition, most ailments in this society are brought on by behavioral choices. The amount of money we have spent over the years treating ailments brought on by abuse of alcohol, food, and nicotine is alarming. The government shouldn’t regulate the purchase or intake of these things. People must take responsibility for their own actions.It is true beyond any question that the vast majority of the medical problems that I or any other doctor takes care of on a daily/weekly/monthly/yearly basis is caused or significantly aggravated in whole or in substantial part by lifestyle choices. Or rather, the wrong lifestyle choices.
Type 2 diabetes mellitus (aka adult onset), which accounts for approximately 85% of cases of diabetes, is in large part a lifestyle disease, brought on by years of overeating the wrong kinds of foods and then not exercising enough or at all. Diabetes then contributes to coronary artery disease, peripheral arterial disease, renal failure, retinopathy, et cetera, et cetera, leading to blindness, dialysis, limb ischemia/chronic wounds/amputations/cerebral strokes, myocardial infarctions/congestive heart failure, and above all death, as well as all the costs associated with caring for all this morbidity.
Use of tobacco, the delivery system of nicotine, is the leading cause of cancer in this country. top of the list is lung cancer, which is now the leading form of cancer and cancer death in both men and women. (It has been estimated that if genus Nicotiana had never existed, there might be only 5000 cases of lung cancer a year in the entire United States.) But it also contributes to increasing the rates of many different cancers, including but not limited to cancers of the breast, esophagus, stomach, colon, mouth, head and neck, and just about any other body part you might want to mention. In addition, good ol' tobacco is the primary cause of emphysema/COPD, another leading cause of morbidity and mortality. Anyone who has any exposure to what is entailed in treating a person with any kind of cancer can just begin to grasp the immense sums used to treat this nationwide.
Alcohol is a special case. It not only causes medical problems when overused, most notably cirrhosis but also brain damage, increased risk of cancer of the esophagus and breast, and even heart muscle injury, but it also causes injury, in the form of trauma from falls, motor vehicle accidents, and other injuries from the poor judgment of inebriation, both to the user and to anyone who might have the misfortune of being at the wrong place at the wrong time. I'll throw in with alcohol the misuse of other drugs of abuse, both illicit and prescription, though the direct medical effects of these are somewhat less problematic than their effect on increasing traumatic injuries.
And this just addresses the poor lifestyle choices Ms Zoller mentioned. There are many others that I could discuss -- unsafe sexual practices, daredevil stunts and other risky behavior, use of stereo equipment and headphones at levels louder than jackhammers, cell phone use while driving, et cetera -- but you get the idea.
Ms Zoller adds:
If you’ve smoked for 50 years and Medicaid stops paying for your $400-a-month respiratory medicine, you shouldn’t complain. You had the money to smoke all those years; don’t expect the government to take care of you when you did this to yourself. So while the government is having this debate, you should quit smoking, start walking, moderate your vices, and we’ll all do better.I have said something similar to this before. I like the way she said it better.
Moralistically, ethically, legalistically, is it right for someone, anyone, to abuse their bodies and then expect everyone else to pick up the tab? Of course not. You infringe on my rights when you request or even worse require me to pay for your care (through taxes) against my will or without my consent. Yet this is where President Obama's healthcare "reform" is taking us. (I am going to have to find another word to use for his plan; reform implies an improvement in that being reformed, and Mr. Obama's plan is definitely not going to be any kind of improvement.)
The big problem that we must face with all of this is that what we currently consider the healthcare system is NOT designed to deal with this problem. In this point, Mike Huckabee almost has it right. He says that we must try to improve health, as opposed to improving healthcare. Be aware that what we call healthcare or the healthcare system is nothing of the sort. It is actually a medical care system with a centuries-old tradition and legacy of diagnosing and then treating medical and surgical illnesses. The emphasis of this system has never been to try to improve health but rather to restore health as best as that can be done. To ask this system to take on the more Herculean task of improving health while continuing to serve as the nation's medical care system and while "reducing costs" (cutting payments to healthcare providers) is not only asking more from these providers than human beings can be expected to give, it is also a recipe for mediocrity at best and utter failure at worst.
No matter how hard I try or how much I might wish to have the ability or the power to do so, I cannot improve your health. Only you can do that. Each and every one of you. Only you can put down the fork, get out of the chair and exercise, throw away the cigarettes and pour out the booze. And even then there's no guarantee. Sometimes bad things will still happen to you, and you won't be healthy. You'll be sick. That's when my job begins. But even so, I still try to cajole you into taking better care of yourself. And maybe 5% of the time, usually less, I am successful in getting you to do it.
Why don't you? What does it take to get somebody to take on their responsibility to themselves? I wish I knew. Because that's what it's going to take to improve health -- figuring out how to incentivize people to take better care of themselves. I can tell you from experience that trying to motivate them by promises of better health or warnings of dire consequences is not enough for most people. But I'll be damned if I know exactly what it's going to take to fix this problem.
But I do have an inkling of what it's going to involve. Money. Figuring out some way that a person can achieve a monetary gain from taking care of themselves is what it's going to take. Appealing to someone's higher nature isn't going to work when the food, tobacco and alcohol are appealing to the baser instincts. To win this fight, we're going to have to win over the reptilian core at the center of all of our brains. The only two things left to work with are sex and money. And somehow, I don't see sex as being a societally acceptable solution.
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