Amid the ballooning costs that plague the complex U.S. health care system, one idea seems to be universally acknowledged; change is required. Some seek to change current legislation, others request a full Affordable Care Act (ACA) repeal. However, debates in the political arena are mired by pre-existing conditions and who foots the bill.
Left by the wayside is how to minimize costs at the level of prevention.
Consider vaccination: many accept that a small price to prevent a disease is better than several thousand dollars to remedy it.
If a parent decides against routine childhood vaccinations and their child gets a debilitating, costly disease which decreases their quality of life and elevates the risk of many comorbidities, the community suffers a larger burden that could have been prevented for a nominal cost.
This parable parallels the nationwide obesity epidemic; lifestyle choices beget negative—yet avoidable—consequences. Preventive care is intimately tied to the concept of personal responsibility.
The system’s broken, doc
Unfortunately, data indicate that many Americans are not caring for themselves. Medical care is heavily skewed to combat existing problems. This situation has produced a system that hemorrhages money for care and a population that simultaneously becomes less healthy. Something has to give.
Obesity, a generally preventable disease with roles in Type 2 diabetes, atherosclerosis, depression, osteoarthritis, and myriad other diseases, is the poster child of comorbid conditions. Its prevalence and trajectory are harbingers of increased medical costs.
One in three American adults is obese and according to some estimates, one-half of adults in the U.S. will be obese in little more than a decade. Weighing the costs per capita in obese versus healthy patients, and the decreasing age of onset, it appears obesity and its derivatives will become unaffordable by those who bear the fiscal burden. Current efforts seem doomed to contain this chronic condition.
“I have a right to live how I want.”
As providers, it is difficult to address this topic without sensitivity and empathy. Autonomy must be respected regardless of a patient’s weight or smoking and drinking habits. Yet, autonomy is a great argument against a single-payer health care system; although some choose to live recklessly, the more health-minded should not be mandated to cover such damaging lifestyle choices.
Skin cancer from tanning beds or injuries to an unrestrained driver are other examples that certain behaviors cause poor health outcomes. It’s clear cut. Applied to health insurance, this concept would shift the approach to primary and preventive care to discourage high-risk behaviors and tackle the key issue of unfettered increases in costs. Instead of higher taxes for everyone to offset risky behaviors, Americans should be held individually accountable for their wellness. They maintain autonomy to eat, drink, and be merry. But, the health-minded shouldn’t be on the hook for the financial consequences.
The government’s role
Although universal care is derided in this opinion, government does have a key role in the vision. States could limit the sugar content in beverages, tax fast food, or dictate that the waist-to-hip ratio become a “new vital sign,” rewarding providers with better health outcomes regarding obesity.
Legislation could take years, but if the private sector deters disease through old-fashioned behavior reinforcement, savings would follow and lives could be improved. After all, an ounce of prevention is worth a pound of cure.