Its about making people who have poor lifestyles pay more. It should be similar to life insurance.
If you smoke , pay more
We could just limit it to 2 items, 1) Smoke : yes or no
2) BMI over 25%, over 30%, over 40% etc. then pay more.
If they choose to pay a higher premium and then still dont change, at least the cost was equitable considering the increase premium payments.
All those other countries who achieve better health at far lower cost do not do this.
Once again - why aren't we learning from them, instead of going off in our own, invariably wrong, direction?
2
Wow - This article and the acknowledgements from the residents explained everything about the attitude of medical providers I've been having over at least ten years, if not more. (Even as I do not smoke, rarely drink, am not obese or engage in any vices or risky behaviors doctors could point to). And why it is so much worse in the US, where welfare or caring for the less fortunate appears to be a dirty word, than, say, France. It also explains why the older American doctors I've had - many retired - were so much more compassionate than the younger ones now; I'd thought it might be due to wisdom and experience, this is much more serious.
4
So, the beatings will continue until the patients choose to make the effort to get well? The irony here is that American physicians and the "healthcare industry" they choose to work in have no idea why humans get sick and are getting sicker by the day. No wonder the cost of healthcare and the attempts to control those costs are increasing. After a lifetime of medical practice and research, I have concluded that the culprit is "population density stress": a combination of our over-active stress response, our disrupted ancestral clan social structures, and our near complete alienation from the healing forces of nature in the raw. Thus, our hunter-gatherer contemporaries have almost none of our ubiquitous fatal "diseases of civilization". What's so different about their lifestyles? They're more active, they eat a diverse and hard to come by diet, they live their whole lives in tightly knit clan social groups, and they are always in close contact with nature, on which they depend. Their population densities are a tiny fraction of our urbanized Western world. Is this really so difficult to comprehend?! Stress R Us
1
This presumes that we can accurately say what the optimal lifestyle for health even is. For older women, do HRT? avoid HRT at all costs? Eat a low-fat, high-carb diet? Avoid carbs? Cut out gluten? Gluten-free is bs? The resveratrol in red wine will help cholesterol levels? Never ever drink alcohol? Cholesterol levels are the be-all and end-all for heart health? They don't really matter? Yes, we can agree on some habits as healthy or not, but the idea that we can ascribe a fair premium to a lifestyle is nuts and right-wing justification gone wild.
1
I need to call out the author's unconscious bias.
Look at "Did they do drugs? Were they fat? Why did they drink so much?" The use of the active voice for drugs and drinking make it seem like a choice, while the passive "were fat" implies that obesity is something that "just happens." Drugs or drinking behaviors bad enough to make one sick may be better understood as addictions and illnesses in their own rights, rather than choices.
2
How about we cut health care for mean and judgmental people? We might live longer--or we might not--but we'd be happier while we lived.
2
Should we begin educating children on how to suffer emotional beatings at the hands of GOP leaders due to adverse circumstances
Chance plays a role in life, despite the Ayn Rand mis-interpretations of the House Speaker ... Life is not fair. No need to exacerbate the unfairness with punitive rules
2
There is an interesting article (to me as I am Canadian and GO FUND ME is only used for drugs with extortionate prices and people trying to go to the USA for experimental surgeries.) in MOTHER JONES that GO FUND ME and other related platforms have become the defacto medical insurance of many Americans. Most campaigns are not successful and these platforms take a big chunk out of the money raised.
1
We see examples of unhealthy choices in people around us every day, and are tempted to judge others, knowing nothing about them or their backgrounds, and feel oh so virtuous by our commitment to good choices. I could easily go there, and do, from time to time. However my own story is of a life of eating self prepared meals from real ingredients, seldom cracking a box or opening a can, baking from scratch, never smoking, drinking only moderately, exercising regularly, and refraining from watching television, as it is too sedentary. In twenty years I’ve had one cold, have not had the flu. I did get pneumonia once, during a stressful time in my life. But, despite all of this personal responsibility, got aggressive breast cancer at 64. After twenty weeks of chemo therapy and a double mastectomy, I’m back, but more understanding that sometimes disease just hits a person. Even when I see a person smoking and my inherent judgdiness pops up, I remind myself that I don’t know their story. Yes, they may be under the illusion that they are immortal, but they also may have been struggling with a worse addiction. I don’t know. It’s not for me to say. But, I sure hope that they can get healthcare when they need it.
10
In an age when we are supposed to be a society that cares enough to see that all of us receive the health care that we need, we still have those among us who insist that people with no assets — often homeless and frequently missing meals — are supposed to exercise “personal responsibility” by paying funds that they don’t have as a condition for receiving essential medical care. It is completely irrational and inhumane to have consumer-directed, moral hazard-based policies that erect financial barriers to care for the four-fifths of the U.S. populations with minimal or modest resources.
As many states abandon the poor, they have engaged private, for-profit companies to manage Medicaid services. Profit for these private companies depends on spending as little as possible on Medicaid patients. It’s hard to imagine any greater disconnect between public good and private profit: The interest of private health insurance companies lies not in the obvious social good of delivering quality health care for patients, but in having as few as possible treated as cheaply as possible. No better example exists of a private-profit enterprise that feeds on the misery and ill-health of man, trying as hard as it can to be sure that nothing is done to decrease that misery while demanding further payment to secure a profitable bottom line. Profit over patients is their disgusting mantra.
As many states abandon the poor, they have engaged private, for-profit companies to manage Medicaid services. Profit for these private companies depends on spending as little as possible on Medicaid patients. It’s hard to imagine any greater disconnect between public good and private profit: The interest of private health insurance companies lies not in the obvious social good of delivering quality health care for patients, but in having as few as possible treated as cheaply as possible. No better example exists of a private-profit enterprise that feeds on the misery and ill-health of man, trying as hard as it can to be sure that nothing is done to decrease that misery while demanding further payment to secure a profitable bottom line. Profit over patients is their disgusting mantra.
10
But we are a community, a nation. What we do impacts our personal lives and also the lives of others, many many others.
The easiest and cheapest way to encourage personal wellness and responsibility is to underwrite universally available and affordable family planning and birth control for everyone living in the U.S. So many many families become dysfunctional economically and emotionally because of an unplanned/unwanted pregnancy. Right here, right now, having a child is costly in money and in personal energy. When most folks are either in poverty or in danger of falling into poverty, an unplanned child is a disaster. All a families assets of energy and money are threatened by the needs of that child. AND AND AND
when a family is destabilized then physical, social, and emotional damage occurs: the most vulnerable is the infant/toddler/child.
Family destabilization leads to abuse and neglect which is the most common preventable cause of mental illness. The mentally ill all go through at least periods of not being able to care for themselves and cannot be personally responsible. And many many folks are just mentally ill enough to be irresponsible without actually committing crimes or suicide. To be responsible you must be mentally healthy. To be mentally healthy you need a healthy childhood free of abuse and neglect. So BIRTH CONTROL.
The easiest and cheapest way to encourage personal wellness and responsibility is to underwrite universally available and affordable family planning and birth control for everyone living in the U.S. So many many families become dysfunctional economically and emotionally because of an unplanned/unwanted pregnancy. Right here, right now, having a child is costly in money and in personal energy. When most folks are either in poverty or in danger of falling into poverty, an unplanned child is a disaster. All a families assets of energy and money are threatened by the needs of that child. AND AND AND
when a family is destabilized then physical, social, and emotional damage occurs: the most vulnerable is the infant/toddler/child.
Family destabilization leads to abuse and neglect which is the most common preventable cause of mental illness. The mentally ill all go through at least periods of not being able to care for themselves and cannot be personally responsible. And many many folks are just mentally ill enough to be irresponsible without actually committing crimes or suicide. To be responsible you must be mentally healthy. To be mentally healthy you need a healthy childhood free of abuse and neglect. So BIRTH CONTROL.
8
Cut out the bit about fat people. One would expect NYTimes to be more sensitive to such issues. Stop demonizing obese people. I have observed too many articles in NY times include careless remarks about obese people with contemptuous implications. I expect better from you.
5
After decades as a Pediatric sub specialist I am amazed at the intolerance some people have for human foibles.
Were my adolescent patients with kidney transplants, Lupus, JRA, Rheumatic Fever, Crohn disease etc non compliant with taking their medicines. Yes.
Did some of them lead dangerous and unhealthy life styles. Yes.
Did I talk to arresting officers and sheriffs trying to keep my patients in jail on their diets and medicines. Yes.
Did I refuse to take care of the miscreants. No.
Being human means not being perfect. Tolerance is a grace.
Were my adolescent patients with kidney transplants, Lupus, JRA, Rheumatic Fever, Crohn disease etc non compliant with taking their medicines. Yes.
Did some of them lead dangerous and unhealthy life styles. Yes.
Did I talk to arresting officers and sheriffs trying to keep my patients in jail on their diets and medicines. Yes.
Did I refuse to take care of the miscreants. No.
Being human means not being perfect. Tolerance is a grace.
9
Maybe we should financially reward people for staying healthy!
What a good idea--reward people for having great genes and good luck in staying healthy, but penalize people who, through no fault of their own (i.e., they do everything right, but still get sick) have to use the health care system on a regular basis.
Gee, that's not discriminatory, is it?
We give ourselves too much credit for our good health, and too much blame for our bad health. People need to do everything they can to stay as fit as possible, but luck is probably the biggest variable of all.
8
So the plan to save our health care dollars is to ensure that people are required to live in such healthy ways as to avoid sickness and reach old ages, when Alzheimer's and other forms of dementia take their tolls. People in that position may spend years in nursing homes with intensive care, with this kind of care for the aging in their last years the number one driver of costs. That doesn't sound like a good plan to me. Unless the next step for the government planners really is death panels. And it's still not a good plan at all.
1
At the entrance to Barnabas Health Ambulatory Center in Livingston NJ are large posters of fit, healthy looking middle aged women with captions like "you eat only organic, you run marathons...but you still need a mammogram".
Part of this issue is the medical profession reiterating to eat well, exercise, etc. as guidance to avoid or mitigate nearly all illnesses and diseases. Clearly this is desirable, and often not followed, but it omits other factors that either can't be directly controlled such genetics or those that are shared functions of government and industry such as pollution, dangerous work sites and, somewhat ironically, access to healthcare.
It is not only political beliefs and a Calvinist heritage that emphasizes personal accountability here to the detriment of other factors, but the medical profession itself.
Part of this issue is the medical profession reiterating to eat well, exercise, etc. as guidance to avoid or mitigate nearly all illnesses and diseases. Clearly this is desirable, and often not followed, but it omits other factors that either can't be directly controlled such genetics or those that are shared functions of government and industry such as pollution, dangerous work sites and, somewhat ironically, access to healthcare.
It is not only political beliefs and a Calvinist heritage that emphasizes personal accountability here to the detriment of other factors, but the medical profession itself.
5
“The medical professions“, doctors and nurses et al, probably had nothing to do with those posters. Those were designed by the advertising firms hired by the hospital MBAs to promote sales of services. Doctors are way too busy entering data into electronic health records to be involved in designing posters such as that. If the doctors there are there anything like the ones I know, they shake their head as they walk past the posters also.
What the article does not mention are the significant structural impediments to taking personal responsibility. Through demonstrable action, the full weight of government and corporate interests conspires to create an obese, unhealthy, sedentary, addicted populace devoid of personal agency. It is through this strategy that those parties are able to consolidate and entrench their personal and collective power while earnestly and piously placing blame with those having the least resources and levels of support. It would be laughable if it were not so intentionally cruel. What we have created is a scenario that cannot avoid a reckoning.
9
So what, exactly, is an unnecessary ER visit? You have to be very careful with that designation. If I go to the ER with symptoms of a heart attack, and it turns out to be indigestion, was that "unnecessary" simply because I was wrong?
If the answer is "yes" to anything that ex post should have been treated in the GPs office, then we are not providing care.
7
I was hospitalized 3 times last year, which is about as many times as I had been the past 62 years. Once was because of a mix up in hospital records and once was because of a severe allergy to anesthesia used in outpatient surgery. It appears to me that the best way to avoid unnecessary treatment is to avoid treatment.
7
How stupid. I read nowhere about daily exercise, no refined sugar, no smoking, regular meditation, and an active intellectual life. I am 70 & look like I'm n my 50s due to the above.
2
My sister was no less virtuous and died at 52 of aggressive breast cancer.
11
Don't worry, guys, we healthy and wealthy folks can only gain by cracking down on the unhealthy unwealthy around us. And if untreated TB spreads, if MRSA spreads, or whatever communicable illnesses break out untreated and mutating, we can just close the gates of our communities and live on our supplies until the unworthy are gone. And gotten rid of somehow. And things sterilized and such. Because it's not as if we're all in this together, is it?
19
The message getting through to me from the US government and corporations is that unless you are working and paying taxes or in the military, you might’ve well die when you get sick. You’re not useful anymore. It doesn’t matter whose fault it is, you are no longer a capitalist asset, you are a cost. There’s nothing humane about this. And people are too tired from working all the time or escaping into tv or movie or gameland to care.
13
Lots of people boast of excellent health, until one day they can’t anymore. If you are suddenly and unexpectedly diagnosed with cancer, despite your extremely low blood pressure and enviable resting heart rate, whose fault is that? This happened to my husband, who is still a long way from Medicare eligibility.
23
Agree. In April last year I boasted to my doctor of my excellent health. Then I got a mammogram. Surprise. At age 47 I was diagnosed with breast cancer. I am not fat. I exercise daily. I eat healthy foods. Some things just happen. Things can turn on a dime and not be "anyone's fault."
14
There are many things we can't control--our genes, the environment in which we live, the level of pollution in the air, etc. but there are things that we can control--the amount of alcohol we put into our bodies, the types of food we eat (maybe not organic but we can choose to eat more veggies and fruit than big macs and fries), etc.
There does need to be some degree of personal responsibility because we do have choices. Wealthy people tend to have a lot more choices than those in lower socioeconomic conditions. What would be helpful is for the government or non-profit organization to provide practical food choices for people at different income levels. I think a lot of people would like to make better food choices for themselves and their families but are unsure of how to do it and what they can actually do given their budget. If an organization actually takes the time to plan a week's worth of meals for X dollars so that people with an income of Y can still eat healthy, I think that would help a lot of people take steps in the right direction.
7
With the government failing to give honest advice about how to eat healthfully, and instead supporting profit-making by unscrupulous food and agricultural corporations, it is unfair to make people responsible for their health. Most people have no idea how to eat healthfully, because of the confusing information bombarding them. And medical professionals don't know enough about nutrition to save themselves, let alone their patients. The government is for profits. This "personal responsibility" thing is just a way to avoid spending money to help people.
19
The same administration rolling back protections on our environment and allowing known carcinogens back into our food supply is the same one demanding "personal responsibility" for our health. Well, isn't that just rich?
40
This problem reflects the current attitude toward causation.
As a physician I was asked “why did I get this” many times a day.
Most people would rather hear that is was something they did or didn’t do rather than the workings of genes, the environment or ,most commonly, random chance.
Western culture’s Newtonian belief in a predictable,clockwork, universe is strong.
Bad luck is a disturbing option. It’s out of our control.
Finally a simple test: when you are a passenger in a car do you do the one thing that greatly minimizes your chance of injury or death? Hint it’s not wearing a seatbelt.
The answer is to ride in back not in the front passenger seat.
Should we deny medical care to accident victims who are “riding shotgun “ ?
14
Well, if personal responsibility dictating health care happens, then corporations shouldn’t get subsidies and tax breaks from the government to farm in unhealthy ways (CAFOS, pesticides, herbicides, and antibiotics) or to sell foods that are unnecessarily packed with chemicals, excess sugar, food coloring, or fat. If so, then the government would be part of the problem.
19
A great deal of illness is caused by corporate pollution and poverty not personal life styles. Holding individuals responsible for their illnesses is an upper middle class ideal!
20
"Personal responsibility" is a notion that first of all simply means that what you do has an influence on your health.
It also suggests that each individual has full control over what he or she does, independently of his/her gender, social class, education, culture, wealth etc., and this is where the misunderstandings (and bad policy decisions based on them) start, because there's not one single scientific study claiming that such a suggestion would be or could be true.
It's no coincidence, for instance, that America has a popular food culture that, contrary to what poor people around the Mediterranean eat, is particularly unhealthy, and that simultaneously the US has a much higher percentage of obese citizens than let's say Italy.
In the meanwhile, a lot of studies have already shown that public campaigns such as Michelle Obama's "Let's move", or healthier school lunches, or more affordable healthcare and as a consequence more frequent access to a physician (and his advice) have an important and positive effect on the overall health of a population.
On the other hand, bad habits such as smoking are often linked to jobs in highly stressful situations and/or the absence of access to stress-lowering activities, so here too, we as a society can often achieve what an individual alone can't, precisely because human beings aren't "atoms" floating around, we're "social animals", as Aristotle already said, so who we are and what we do, is co-determined by where we live...
10
I have become somewhat more sympathetic to the need for "personal responsibility" in health care, particularly in a publicly supported insurance system. Smoking, obesity, high-risk behaviours or recreation, drugs, or plain stupidity are a big drain on resources. Think of an ICU bed occupied by a drunk driver rather than a stroke patient, or the victim of his reckless behaviour. Is there a decision to be made there?
But the subject that rarely comes up in policy discussions is that we're dealing with fellow, fallible human beings living in a variety of conditions and the moral implications of diminishing their lives through sins of commission or omission dictated by policy. That's a frightening world for all but a few.
10
I once worked in a pediatric dental office. The dentist saw children that were on medicaid, although it paid less than insurance. However, many of the parents were worse than blase about this benefit. Many times they would not show up for appointments for their children and the office then had a loss, as the time was booked for an extensive procedure. They had free transportation to the site, courtesy of Texas medicaid, yet, still couldn't bother to come in? Their children had painful cavities, yet they still didn't make the appointment? Yet, people complain when dentists and doctors don't want to see medicaid patients. They don't work for free, when someone doesn't show up it's a loss for the office. A little personal responsibility would be nice once in a while.
3
Even for them, even for them. There might be a God.
2
Well, it is possible that those parents had other things come up. What if they couldn't get off work? Many people do work low-paying, no insurance jobs, and their kids still receive Medicaid benefits. Maybe their spouse or relative got sick and they had to tend to their needs. Maybe the parent got sick and didn't have anyone to escort the child in. the office.
I'm not saying people don't occasionally slack off, but why only blame the poor? Other people may be equally "irresponsible".
A little compassion would be nice once in a while.
The problem with making people responsible for their health is that even the professionals disagree what is "healthy".
A system that depends on the foundation that people can accurately gauge the statistical correlation between behavior and outcomes is unworkable. If people with PhDs and supercomputers cannot get it right, what ability for success does the average citizen have?
These attempts at lowering U.S. healthcare costs are ultimately about frustration. Being unable to remove the high cost of services and products due to POLITICAL and ECONOMIC impediments, we have resorted these sorts of schemes that sound good on the surface but ultimately are unworkable when implemented.
As long as Americans refuse to accept that a working healthcare system is an all or nothing situation (it is either a right or no one has access), the result is always going to be what we have.
8
The recent efforts of some states to get people on Medicaid to work for their benefits seems to have a historical precedent. During the Irish Famine, starving inmates confined to workhouses were made to work for their food, in order to cure them (in the words of one religious do-gooder) of their "dependency on the potato", one of the few crops they could grown on soil poor scraps of land.
The Famine was seen by many English as a result of the Irish's own poor choices. Not surprisingly, this corrective approach did not work. By the end of the Great Hunger, more than a million Irish had perished in just five years.
Forcing people to work for health benefits will have disastrous consequences for the poor on Medicaid. What type of work will they be able to secure in economically depressed areas of the country and if denied benefits, how much longer can they expect to live?
20
One way to cut costs is to eliminate the middle man -drastically reduce the number doctors and allow patients direct access to a representative from the insurance company. The insurance companies pretty much control ones access to medical care - all they need is a few treatment protocols, plug the patient in and all problems are solved. Certainly, the insurance executives will be pleased to share the windfall with their patients and an extra bonus ($$$) will result from the elimination of the time consuming and costly process of educating physicians. What could go wrong.
5
It is all summed up in the very last worthy ideal --> In a nation as wealthy as the United States, sick humans deserve health care — even if they can’t pay, and even if they've made some bad choices.
16
Republicans say it's your fault, and they're not going to help you get better because it will cost them money and they don't have enough for themselves, so therefore they would appreciate it if you would just crawl away and die somewhere.
15
the creation of the class of those worthy to die. Unless they can pay on the way to there own doom
5
"Personal responsibility" is nothing more than a deception, an attempt by the Party of the Rich to paint their piggish contempt for the non-wealthy with the lipstick of "morality."
The Republican approach to health care and the social safety net reflects their donors' belief that their wealth is an inviolate entitlement that must not be confiscated as taxes to benefit anyone else. Government should thus be exclusively devoted to protecting their interests and facilitating the transfer of the nation's wealth to their offshore bank accounts. Everyone else should be left to the "free market."
That policy is difficult to sell to the millions of non-wealthy people Republicans need to consistently and enthusiastically vote for them. So they have to create alternative reality to make policies that exclusively serve wealthy donors appealing. The wealthy become "job creators" who will trickle down their wealth once Republicans cut their taxes and eliminate regulatory impediments. And the poor become "moochers" and "leeches," intent on stealing the crumbs Republicans leave the non-wealthy.
Similarly, "personal responsibility" becomes the justification for cutting health benefits for people who are sick as well as poor because they've "made the wrong choices." We should not allow Big Government to take our taxes to support "those people" who are entirely to blame for being sick. The resentment donors feel toward their inferiors is the only thing that actually trickles down.
25
Thanks, Pdxtran, I like your take on magical thinking. I also hate the fact that my tax dollars are used to subsidize churches which indulge in the same. I'd like to tax the churches, and see my money go to health care for ALL and helping the poor. The problem with this country is that our taxes subsidize the rich, the church, and the military - basically a medieval, feudal system.
33
I definitely favor personal responsibility. I am particularly interested in personal responsibility for drivers who injure bicyclists and pedestrians and get away with it, secure in the belief that owning a vehicle means owning the road.
Bicycling is excellent exercise and good for social interaction and community engagement, and it requires far, far less infrastructure expenditure than automobiles. So let's make it safe to walk and bike around town. Let's hold drivers personally responsible for their role in making it dangerous for adults and kids to ride bikes.
We could make a good start with (a) mandatory prison sentences for drivers intentionally or negligently making or threatening contact with non-motorized traffic, (b) full and automatic financial responsibility for the driver or his/her insurer, extending a lifetime if necessary, to cover medical costs, loss of income, and loss of function, for bicyclists so contacted, and (c) gas or registration taxes sufficient to support a nationwide network of safe (i.e., physically separated) bike lanes, parallel to each street and road in the nation, if measures (a) and (b) prove insufficient to protect bicyclists and pedestrians from irresponsible drivers.
So, count me in. Let's hold those fatties responsible for their contribution to higher national healthcare expenses! Oh, and drivers too.
3
My dad got hit by a bicycle messenger back in the 80's.
He broke the messengers jaw for doing so.
4
And let's also hold bicyclists responsible to have a light and wear reflective clothing after dark, and not dart in front of moving cars.
6
This blame the patient makes me see red. My mother died from a very aggressive breast cancer at the age of 49. She was so bitter and angry. I was three months pregnant. The oldest of several siblings, she had taken care of them all. She was on the brink of moving to a place she loved when she was diagnosed. I don't care what a person did or didn't do, what the context is....someone is ill, the only response is to heal or comfort.
24
When we can't afford the care or we're worried about meeting a high deductible, paying a co-pay, paying a premium, and making sure that the services rendered are acceptable to the "health insurance" company it often means we won't bother to go for any care at all. And that means that a good many of us, who would benefit from preventive care, follow up care, or just plain care, don't.
The idea that one should not be forced to contribute because others have bad habits is ridiculous. For the sake of public health alone it defeats the purpose of preventive care and endangers the health of others. We went through this with AIDS: our more narrow minded politicians, along with quite a few very pious people decided that AIDS was divine retribution rather than a disease to be treated.
The truth is that no matter how well we plan our lives or not, things happen that are beyond our control. People become addicted to opioids after they've been prescribed. Some people take up smoking and can't quit. Others overeat. And some people who are healthy and have healthy habits develop serious illnesses while others who do the opposite, don't. Those are not good reasons to oppose universal health care.
22
Like the right-wingers who say that people are poor because they are lazy and made bad choices, those who blame health problems on poor decisions are indulging in magical thinking.
"I'm not like that smoker/drinker/fat person, so I'll live to a healthy old age" is the first cousin to "I spend my money prudently and have a good job, so I'll never be poor."
This self-righteous attitude leads to another, more self-destructive assertion: "I don't want universal health care, because I don't want my tax money going to treat people who have bad health habits or people I disapprove of for any reason."
Think about it. They are so determined not to give anything to people they disapprove of (whether out of moral indignation or bigotry) that they are willing to forego the kind of universal health care that other Western countries enjoy.
I can't wrap my mind around it.
27
The author writes: "Behavior contributes to nearly half of cancer deaths in the United States, and up to 40 percent of all deaths."
The first citation refers to a popular news magazine with no links to the actual study. The second refers to a NEJM article that draws the 40% statistic from yet another article, this one appearing to be a summary in JAMA, associating numbers of deaths with specific behaviors, with virtually no info dabout how that number was calculated.
How do we assign causes of death? I knew an 80yo woman who smoked a pack a day, with no symptoms of heart or lung disease. Got checked regularly. When she dies in her 90s, will her death be attributed to cigarette smoking?
Thin, fit people get diabetes. Non-smokers get lung cancer. Donald Trump avoids exercise, eats junk and remains free of heart disease and diabetes.
From that NEJM article: "Smoking is increasingly concentrated in the lower socioeconomic classes and among those with mental illness or problems with substance abuse."
Missing from the discussion are (a) medical error: a heart surgeon's fatal mistake gets recorded as death from heart disease; (b) assuming longevity as desirable outcome, when an early death might be kinder than a long period of painful illness
Perhaps we should encourage a new form of health behavior: learning to interpret statistics in a medical report.
15
The same misinterpretation of statistics happens in the UK. Media report that 3 rashes of bacon week can cause bowel cancer. They don't say it might increase the risk of bowel cancer. They talk in percentages and fail to mention that if your overall risk of bowel cancer is very low even an increase of 100% will mean that it is still low. There are numerous other examples to do with diabetes, alcohol, obesity etc. It is lazy journalism and it makes me mad.
3
OK, my fault for losing admirably strong health (the first woman ocean lifeguard in Suffolk County, NY), for believing Consumer Reports saying dental amalgam is safe, for believing FDA saying dental amalgam is safe, for believing the ADA saying dental amalgam is safe.
Only after recovering my health after two decades of escalating problems did I do my homework. Costly mistake.
They did not tell me dental amalgam was 50% mercury, which offgasses with heat, chewing and grinding, and that people with certain gene types do not excrete but accumulate mercury in their cells, bodies and brains. They did not require written informed consent for a lasting device installed in me and its impacts on my respiratory, circulatory, immune and neurological systems. They did not tell me that ADA affiliates had held patents on dental amalgam, or gag clauses in its Code of Ethics.
When the FDA and regulatory agencies do not do their jobs, which consumer groups and the media do not do their jobs, when dental and medical organizations have massive conflicts of interest, whose fault is it, really?
13
How about we start with making our President, cabinet members, House and Senate personally responsible for their health outcomes first!
Or whatever poorer citizens on Medicaid have to do to "prove" they are being responsible for their health outcomes, then our state and federal political leaders must do the same.
Let's also have our political leaders keep track of their substance abuse, mental health behavior, obesity and overweight issues and adjust their co-pays and insurance costs accordingly.
What is good for the poor geese is also good for the political ganders dreaming up these health care accountability hoops for poor people.
And while we are at it, why is junk food so much less expensive than healthy foods?
Why does the federal government subsidize big agriculture that uses pesticides, damaging chemical fertilizers, and unhealthy farm practices when we should be encouraging and subsidizing healthy organic farming, not chemicalized farming?
Why is the US only 1 of 2 countries that allows prescription drug companies to advertise to the public?
For older people on Medicare, drug interaction effects are one of the causes of dementia. Why is so little taught in medical schools about nutrition, exercise, & lifestyle solutions?
How did so many people get hooked on prescription opioids? Because the drug companies lied to doctors, politicians, and the public about the safety of these pain killers, when they were actually addictive and do serious damage.
15
Have you ever looked at American School lunches and the lack of proper recess time? Start there.
22
One of the biggest money pits is the ER. Many without health insurance use it as their physician. Hospitals make a lot of money charging for unnecessary IVs and unneeded tests. The hospitalists roam the ER looking for people to fill the beds upstairs. A lot of money would be saved if hospitals were required to have urgent care facilities to take care of a sore throat or the cut which requires a tetanus shot. The medical industry has made it prohibitively expensive to take care of even small medical issues.
People should have to pay a portion of what they owe. Without any cost, people who have good insurance go for unnecessary tests because they don't question their doctors about its purpose or helpfulness in a diagnosis or treatment. They still go for the less than useful annual physical because their insurance pays for it. This, of course, includes blood work which just leads to more tests to find it's really normal. What they consider to be free, costs me money in higher insurance rates. It's not only the poor who should have to pay but those with good insurance who are raising rates for the rest of us by using unnecessary medical services. If you have a cold, stay home.
4
You can't blame people who get unnecessary tests. At one point I had insurance requiring that I visit a primary care physician to get a referral to a specialist for a fairly minor workout injury. The physician's office insisted on seeing me in person. I had to threaten legal action to avoid unnecessary tests. I was lucky. Many, many people have been told the doctor will refuse care if they don't submit to the tests and the follow-ups. And I had the option to change doctors and, luckily, insurance.
Since then I've learned to bring citations of published medical research. Once doctors realize I can read a medical journal the conversation changes. It does require an investment of time and energy. that most people won't have.
13
Perhaps Americans should take a closer look at the power of advertising and what it is doing to the health of the country. TWO of the biggest spenders on advertising, especially related to television, are the Food and Pharmaceutical industries, they spend BILLLIONS every year.
The Food Industry wants to continue to sell mostly unhealthy fast foods while the pharmaceutical industry wants you to buy a pill that will help cure the problem caused by eating too much fast food in the first place! For starters, start with the pharmaceutical industry. America is one of only TWO countries in the world that allows pharmaceutical advertising.
If you want Americans to have better nutrition and lifestyle, deal with that, NOT the easy way out by assuming a pill is going to be the answer to all of your problems.
11
Those advertisements are insurance for the drug companies.If 1 of your largest advertising clients was doing wrong,would you do a story about them?
Would you do watch dog fact finding exposes on your largest clients?The answer is NO.That and mgmt. of both the networks and the drug companies attend the same country clubs and the same synagogues to do Bar Mitzvahs and Bat Mitzvahs for their children.
2
So much of "choices" are a matter of environment.
If junk food and cigarettes are more available to someone than healthy food, that's going to effect people.
If someone is working a job that expects 70 hours a week, does anyone anticipate a healthy exercise regimen?
People should be making good choices and society should be facilitating them.
13
So so many topics we as individuals need to tackle concerning our health. I zero based the journey we travel from inheriting the genes of our parents which we are clueless of, then many of us choose a partner whose genetic make up we are clueless about and then we bring children into the mix. I would suggest before we choose a spouse we should know the pros and cons of as much of genetics/DNA we can learn. In my family we experienced a disease of the immune system that is genetic, we were unaware it was somewhere on one side lurking. After considerable research at the NIH were three are in a trial they know it is genetic and they know we have to take in-vitro measures not to pass it on.
We're not good with chance or probability. Its just part of being human I guess. Its always somebody's fault, your fault the crop failed this year, his fault the river ran dry. Its why we have scapegoats, why we blame religious minorities and cultural nonconformists, why some cultures instill strict restrictions on menstruating women, hunters, or the elderly. Its a big part of why we are superstitious and bigoted as a species. The growth of "something to live for" (land, capital, children, status) has only weighed down the sword of Damocles more and more, and if it falls, someone will have hell to pay for our resulting suffering. Its why science is so reviled by some, because its outcomes are extraordinarily useful, and yet are always probabilistic and fearlessly embrace the uncertainty of the future. We are all playing defense, and that is an affront to our "God- given" dominance and control that we think we have. By extolling "personal responsibility" with a heavy, punishing hand, we extoll our own egos. By claiming there is nothing so sacred that it can't be taken away (be it your health, your wealth, your community), by equating meritocracy with the expectation that you earn and deserve every little thing you get, by calling it "freedom" we're just feeding our own egos. Luck is luck. Bad things happen to good people, for no rhyme or reason, and we just have to suck it up. After the righteous anger passes, you're gonna need a safety net until you get back on your feet.
13
Not that long ago (and it’s still true in many parts of the world) if someone came down with a disease, the people in their community believed that they must have sinned against god, or the gods, or maybe it was someone in their family. This helped insulate the community against the fear of a random, and unpredictable universe.
In our country, in our time, we believe that you must have committed some secret, or not so secret sin against the gods of healthy living. We still fear that random universe.
8
Good drivers get a break on their car insurance, and homeowners in safer neighborhoods get a break on their home insurance, because actuaries are able to calculate that they will make fewer claims. When the actuaries can calculate the savings from healthy lifestyles and present the numbers to the board, the rates will change.
Insurance is a numbers balancing game, but maybe our health system should not be run for profit.
5
There must be a balance, though, or some understood consequences for bona fide neglect of personal health. The old example is the alcoholic with liver disease who, after receiving a new liver, continues to live the life of the alcoholic. One must ask, is that fair to society, the presumption being that society is footing the bill for the liver transplant and all associated costs?
To me, the balanced answer is, the first liver is "free"; were another liver needed or were the same individual to have other, difficulties develop with high likelihood that the alcoholism is reason for the illness, then the answer should be: pay for it yourself.
We could solve all this debate by mandating that all health care, associated services, pharmacology, research, etc., is all to be provided to the public for No Cost...but we know that's not really going to happen.
As well, the underlying issue to the individual who effectively abuses his or her own body by alcohol, drugs (legal or illegal), risky behavior, obesity/eating disorder, and more, is that while all individuals should be able to find assistance to *better* one's life, to blatantly and routinely abuse oneself should have a distinct cost to the *individual*, not society-at-large, and that cost can be simply called personal responsibility.
So again, as an ex-drunk, it's not my responsibility to fix up the drunks who refuse to stop drinking (eating, wrestling alligators, shooting up, etc.).
Free will works both ways.
2
Well, I never drank at all. Why should I pay for anything your drinking left you with? But then, I did smoke for ten years in my youth, why should you - oh, never mind. We don't have enough spies and snitches to do this anyway when people get smart enough to deny their "sins" and hide from their omnipresent judges.
1
We Canadian aren't any less self-conscious about our lifestyle choices because we have a mainly public healthcare system. It is all about trying to avert the tragic outcomes of human life.
I personnally do not understand why any one should have to be even more burdened economically, above all other issues, because of reputedly bad decisions over one's health.
14
Beware Pence and othe GOP of your ilk. “Freedom” means you die on your own dime. The hypocrisy being foisted on the public is not going unnoticed.
14
I lead a very healthy lifestyle, with good eating habits, no smoking, no drugs, enough sleep and plenty of exercise. I still got a disease that led to expensive arthroscopic hip surgery and will eventually lead to a hip replacement. Doctors have no idea why I got this rare disease. It isn't genetic, and certainly isn't due to poor lifestyle choices. My message: don't be so quick to judge others.
75
Good post Nancy. As I aged and noticed ailments many of my friends came down with I began to seriously give thought to genetics. A group of us re-connected as graduates of high school in 1956. Many of us even went to grade school together .When we occasionally meet health issues are a big topic and we go over how we were raised what our diets were, etc, etc. Seems genetics has a place in our health. Preventative health care has two components. A part you can manage and the part by constant testing a checkups seems to go nowhere. Doctors try their best but be assured they find something to treat with drugs.
4
When I was in my early 20s, I ran and lifted weights three times a week; ate organic meat and milk, lots of vegetables, and very little processed food; slept 7 to 8 hours a night; drank rarely; never smoked.
I was diagnosed with lymphoma at the age of 28.
44
My concern re; personal responsibility is that it assumes information that we don't have/can't readily access.
1. We can't say which diet works best for which individual for certain.
2. We don't know how much exercise and what type of exercise works best for which individual.
3. We can't really say for certain what tests are usually unnecessary until after the fact.
Because of these factors it's a little premature to put so much emphasis on personal responsibility as we can't really say what that looks like for everyone or even most people.
27
When I was in my 40s, I was very heavy and developed diabetes. I was treated very judgmentally by my doctor and her staff, until I visited an endocrinologist who diagnosed me with a pituitary tumor which was the cause of both my weight gain and my diabetes. Thanks to the doctor who didn't judge, I am alive today.
72
Victim blaming is why we don't have universal health coverage in the USA. I'm healthy because I'm a good person. You got breast cancer because you smoked or didn't eat organic food or internalized anger or whatever thing the virtuous can come up with to explain other people's bad luck to themselves.
If you can afford treatment, fine. If not, too bad, it's your fault for getting sick and it's your fault you didn't have health insurance.
88
Please read NYT excellent Op-Ed on Chronic Illness and then look at this brutal article about health care in America.
If you don't die in an accident you will eventually get sick, you will suffer and your illness and suffering may last the rest of your life.
We blame the sick because foolishly we think exercise and diet will keep us from being ill. That is nonsense!
Everyone of you reading this will get ill and/or have a love one be ill and not recover and not die quickly .
The only people who survive to 90 without illness have wonderful genes and frankly they can usually eat fatty foods and drink some with no consequences.
Sorry folks I know this nonsense about diet and exercise makes you feel less anxious but one day you will became ill with some disease or as a the good Doctor says;" if you are over 70 and not in pain well you're probably dead"!
35
The edge cases are self-evident. Most people fall into the gray spaces where we (and they) just don't know.
3
This article could go further to explain what causes both chronic health conditions AND trouble following the appointments and protocols: Adverse Childhood Experience, aka childhood trauma -- and specifically attachment trauma. These innocent kids will BECOME their overweight, drug abusing parents soon enough if nobody addresses the family's trauma.
9
Even after adopting a very healthy lifestyle, we live in a decaying planet (thanks to humans) that is filled with toxic chemicals, air, water and soil pollution, plastics, resistant bacteria (overuse of antibiotics), artificial food and a stressful man made environment where greed is king. If this doesn't make you sick one day, you are one of the very few humans adapted to this unnatural way of life.
"We get sick from chronic diseases by doing what we evolved to do but under conditions by which our bodies are poorly adapted, and we then pass on those same conditions to our children, who also then get sick"-The story of the human body-
12
Personal responsibility is code for the Republicans to cut healthcare for Medicaid, Medicare and CHIP etc. I would like to see them cut healthcare for their base and see how well that goes. WHoops, they already tried that and no one wanted it.
15
Anyone still smoking, with all the information available against the habit, should be denied health care or have a plan that costs more than the rest of it. They should be denied Medicaid/Medicare unless they agree to stop smoking and never go back.
5
This is a sick joke from years ago..the best citizen is a man who works hard all his life, smokes, and drops dead from a heart attack after all his kids finish their education.
BTW most of the health care costs occur in the last 6 months of life.
2
When the government stops subsidizing sugar and corn and GMO foods are not created with more sugars, then start blaming the poor for food choices. Food bill was passed 2 years ago and you would be seen as more balanced if you started now to promote access to food that is made cheaper so families can buy them. Addiction to sugar and opioids oversubscribed are not mentioned.
11
Far too often, a "healthy lifestyle" is the realm of the wealthy. People living in the large swathes of neighborhoods with no fresh fruits and veggies readily available, with no parks or equestrian paths to jog on, with no safe neighborhood to even walk around in, with limited access to health care, and with "jobs" not "careers" that keep them seated for 8 hours a day or keep them stressed for 24 hours a day, need healthcare the most. "Health" follows for the privileged, not the poor.
17
Positive measures to nudge people towards a healthier life style work.
A friend works for a company that issued each employee a low cost watch that keeps track of their physical activity. If you hit a certain number in 3 months, you get $ 50.
You might think that $ 50 in 3 months would not make much of a difference
But is does.
5
A healthy diet and exercise improves matters, but nothing can undo the damage done by unnecessary radiation treatments inflicted by a physician during my first year of life. Medicine is an art as well as a science. My brother and I had the misfortune to be under the care of a gadget-happy incompetent. No one can be blamed for my sisters struggle with type 1 diabetes and ensuing complications from the age of 9.
What we need is universal healthcare without judgement. THEN, people would get the support and encouragement necessary to take care of themselves. We also need government regulation of pharmaceutical companies. The prices charged for drugs developed with public money is an outrage.
It’s a scandal, that some of our fellow citizens must choose between healthcare for their family or paying the rent.
26
What about if a cancer gene runs in your family yet you still go and have children?
5
Hopefully you saw a genetic counselor and determined risk. In any case, if the child has inherited a bad combo, you all decide how to reduce risk of gene expression. I inherited a bad combo...luckily someone ahead of me determined that I need methyl B12 and D and I should avoid folic acid in the food supply. I pay that forward rather than walking away proclaiming "I got mine!"
So, maybe you decide to be a part of a group that funds research and finds a cure, as the Amish and Mennonite did with maple syrup urine disease, also a genetic condition. Or many did with various types of cancers. Me, I agree with Strauss - "our failure to improve the lot of most people stricken with genetic disease is no longer a matter of scientific ignorance or prohibitive costs, but of choices we make about how to implement existing knowledge and resources"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477994/ You might be better off financially if you don't have to pay for children born ill, but one day one of your descendents will have a random mutation and be in that situation. Party now and ignore the afflicted cause you got your good health, or pay now and improve the lot for everyone.
5
What if a cancer gene ran in your family so your parents didn't have kids? Better?
1
What does Mick Mulvaney think about someone who is overweight, watches hours of TV and eats McDonald's food everyday? Should we cover that person's healthcare?
30
What about someone who drinks "just" a glass of wine every day, although solid research shows this can lead to breast cancer. What about people who sleep with their animals? What about (fill in the blank ...)
6
Are you talking about the president?
6
You are avoiding the question. Admittedly, the underlying question is, should any and all behavior (legality notwithstanding) be NOT considered in respect to health care?
It seems right to say that of course, no one should be judged in any sense and thus, be denied health care.
And that makes wonderful sense, but only in a world where health care is in fact free. It is not free, though, and we are taxed (partly) to pay for others health care. And one would in fact be hard pressed to conceive of how we could have "free" health care in any sense where either Society foots the bill for bad behavior of others or, more likely, Society will make determinations as to who is abusing the free health care and, if necessary, cut the person out of the system.
Which is only fair, and perhaps, actually right.
Punishment has no place in health care. No one wants to get sick or get into an accident. Punishing people for needing to see a doctor (by making them pay more) just adds insult to injury.
If everyone had access to health care regardless of income or their current health, we'd have a healthier, happier, and more productive country. And save billions. We'd be just like every other country that spends less on health care and has better outcomes.
We are so stingy. And stupid. And mean. Guarantee health care for all from cradle to grave, paid for by payroll or other taxes, and we could stop the endless arguments. It's really quite simple.
29
Anyone who classifies solutions to healthcare as simple, is.
1
"Anyone who classifies solutions to healthcare as simple, is." That's a nifty turn of phrase but it could be simple; Eric is not talking specific diseases here, he's talking about our compassion and intelligence as a country. "Guarantee health care for all from cradle to grave, paid for by payroll or other taxes" Most of the developed world has already figured it out...
1
Our dear friend has run 35 marathons, does not smoke or drink, eats healthy, and has stage four kidney cancer. So much for personal responsibility. The Medical Industrial Complex is worse than the Military Industrial Complex. Why are there Billionaires from Health Care??
61
You are correct the CEO's of Health Insurance companies are some of the highest paid CEO in the country!
12
Why? One has to continually remind themselves that the healthcare industry and those that run it are no different from any other businesses and the CEO's top priority is to maximize profits for the shareholders, everything else is inconsequential, including people who get sick.
Every other developed country in the world determined decades ago that in order to provide the overall most efficient and less costly way to provide healthcare for ALL of its citizens was, for the most part, remove the insurance factor from the system or at best, regulate it. In the case of pharmaceuticals and other equipment, government could negotiate more favorable prices.
America has been haggling about healthcare for over 70 yrs. without resolution and despite all the rhetoric and propaganda to the contrary, the inertia continues because of the money and influence of the industry itself which demands the "status quo".
11
Fault? Hey, Diane Sawyer made the point with the discussion on mammograms at 40 vs 50 -- it's your health, nobody but you is going to look out for your health. Get that genetic screening, get that mammo, get that vitamin D and B12 bloodwork done, see the nutritionist, get your blood sugar etc in control, buy and use a scale; your insurer is not going to pay for screenings for preventable chronic illness that affect only a small percentage of people. They'll wait until its cost effective for them; you don't want to be in the group they chose to sacrifce to the preventable disease. You have better things to do with your life.
7
50% of healthcare spending is spent by the sickest 5%. They've blown through any affordable deductible years ago.
Most of the medical issues that can be improved by "personal responsibility" are things like weight or smoking or physical therapy --- things that require either multiple visits to medical providers or that do better with ongoing support. If you drop a co-pay, it can get expensive.
"Skin in the game" is a nice theory, but it doesn't actually work given the actual needs of patients.
19
I see the focus on the responsibility of patients for their illness as a way to deflect attention away from the irresponsibility of industry and corporations such as tobacco, sugar, and fast-food whose products are addictive and cheap, and the irresponsibility of hospital and insurance corporations who blame patients for higher healthcare costs even though those costs are due solely to hospitals' ever higher prices and deductibles. Patients are an easy mark; they do not have lawyers in slick suits lurking in the halls of Congress ready to kill any law that increases corporate responsibility for the damage they do.
52
Stating that "behavior" causes 40% of cancer deaths is a gross oversimplification. The author's link points to smoking and alcohol use as "behaviors", implying individual responsibility for the behaviors, and the resultant cancers. Instead, the author could point to the behavior of Big Tobacco, and our government's tacit approval of the sale of the only product known to be highly addictive and to kill many who use the product as directed. Perhaps rather than speaking of individual behavior the author should comment on corporate responsibility?
27
Big Tobacco wasn't responsible for me choosing never to light/smoke a cigarette in 46 years.
2
What of the people who do everything right and still get cancer, diabetes or heart disease, will they be penalized as well?
Humans are complex organisms not one size fits all interchangeable cogs in our bloated healthcare disaster.
Genetics more than anything determine our health outcomes. Will insurance companies demand extensive dna testing in an effort to weed out those who may become sick in their lifetime?
Will we all be required to wear apple watches that report directly to our healthcare providers? Will we be receiving calls at 10 pm to tell us that we need to walk another 5000 steps before bedtime?
This is a slippery slope and yet another way to punish the poor who can't afford to live an expensive healthy lifestyle.
47
I'm all for DNA tests if used to aid diagnosis or to help prevent disease. More money spent on diagnosis whether blood tests, DNA tests, CT scans, etc. will assist doctors to not guess what you have. I spent 2 years with limited oxygen due to doctors attributing it my asthma and using that also for the explanation of yearly pneumonia. The issue wasn't caused by my life long asthma, but by a combination of exposure to mold at work that weakened my lungs and an undiagnosed infection.
As far as I am concerned, bring on the robot doctors.
3
These Republicans will do anything to avoid taking on the healthcare profiteers who are running up the cost of healthcare and ripping off the American people. It's easy to pick on fat people and drinkers vs. taking on big pharma, hospital corporations etc.
Also, as the author points out, people who die young actually save the healthcare system tons of money. Most of the healthcare spend on an individual will be spent during the last years of a long life.
33
Whoops, my bad - it's Si (not Sy) Kahn.
1
I am angry. After a misdiagnosed cancer grew large enough to require life-saving emergency surgery, I now have no quad muscle. My hip and right femur broke due to seven weeks of daily radiation. Did I live a healthy lifestyle before this? Yes, I did. You all want to punish me? Go ahead, I'm used to it.
42
A friend of mine who’s a doctor was railing against the ACA a number of years ago because he felt the law emphasized saving money over giving patients the best care he could (though he assured me that money could be saved if doctors were in charge). If “personal responsibility” works for people, that’s one thing, but if it’s just a way to try to economize, it probably won’t. (That’s why Republicans attacked the ACA and why Democrats attacked the AHCA.)
2
"The doctor says I smoke too much, he says that I'm not tryin'. He says he don't know what I got but we both know he's lyin'. I'm gonna go to work on Monday one more time." From "Go to Work on Monday", a song about byssinosis by Sy Kahn. It's simple really: Blame the victim.
1
Any smoking is too much. You are affecting the health of those around you as well.
4
I think that avoiding the suffering of illness is a far more effective deterrent to unhealthy lifestyle choices than avoiding larger medical expenses. What is really worrisome about forcing "healthy lifestyles" upon people in order to qualify for more medical care is: Who is going to decide what is a healthy lifestyle, and how are they going to monitor that?
I can see some states imposing utterly irrelevant drug testing - if you have any marijuana in your system, no health care. Maybe even do a drug test when you enter the emergency room (but only if you are black, of course). Then it becomes a political weapon. Well, fortunately at least alcohol would not be tested, as it isn't a drug.
16
I have to repeat: The issue is not health care spending or health care costs, it's health care PRICING that is the issue. Inserting profit-taking middlemen between doctors and patients is, to me, the major reason so much is "spent" on health care in the U.S. Studies have shown Americans don't "overuse" health care compared to other developed industrial nations, we just pay more.
96
"We pay more?" Then why have 13,000,000 entered the USA unlawfully?
Because many of us, we also get paid more.
1
Correct I believe an MRI in Japan cost $500 here $2000+.
6
You do realize the U.S. population is 325,000,000 right? The number you gave is like 4% of the U.S. total population.
There are more people living in the L.A. or N.Y. metro areas than that. And those are only one of a dozen of major metro areas in the U.S.
I can guarantee you that the U.S. is more expensive than just 4% compared to other countries.
I too believe that we should take personal responsibility for our health. But I notice that almost everything in our culture conspires to keep Americans fat and unexercised, from ubiquitous junk food, candy at the checkout lines, supersized portions in restaurants, residential areas with little walkability, remote controls, luggage with wheels, escalators - the list goes on and on. Yes, each of these things can be dealt with, but it takes near-constant effort and self-control.
19
Agreed. And don't exclude desk work. Most of us sit most of the day. We have to to get paid. That's hardly healthful, but what are you going to do?
2
I have made a standing desk out of printer ink boxes to lift the monitor and keyboard. I stand in front of my computer most of my work day with walking in between.
"Vice President Mike Pence has argued for “bringing freedom and individual responsibility back to American health care.” This Republican dogma totally lacks corporate or business responsibility. Even though we try to eat healthy foods, agricultural business produces pesticide or toxin contaminated wheats, soybeans, corns, or antibiotics-contaminated chicken, pork or beef or milk made from toxicant-contaminated grains. Food and beverage industry sells excess sugared prepared foods after processing toxicant-contaminated grains and meat. Are we responsible for all the diseases caused by such toxins, antibiotics or excess sugar?
32
I think that instead of considering the consequences of poor health negatively by taking away benefits or penalizing people with health issues we should take a more positive approach. Perhaps incentives are offered for healthy behavior instead?
Motivating individuals to live life in good health reduces the cost of treatment. Also, positive reinforcement is more politically palatable than perceived negatives such as taxation and the stripping of benefits.
5
Exactly, this is why a simple $150 gym reimbursement from my insurance company is such a great motivator. It does little to hurt their bottom line, but keep me healthier and saves them money in the long run.
1
Even though I'm as liberal as they come, I still think people need some skin in the game when it comes to healthcare. If you make something free, people will overuse it. Visit any emergency room, and the nurses and doctors can rattle off the names of dozens of "frequent fliers" who visit the ER on a daily or weekly basis for anything ranging from a stubbed toe, to a cold, to a headache, to simply fishing for drugs. The reason: these people are generally unemployed and have no health insurance or state-sponsored insurance. It costs them nothing to visit the ER, and anything the hospital bills the person will be entirely un-collectible. They have no incentive not to visit the hospital because to them it's free treatment. Meanwhile, those with jobs and insurance face significant co-pays and deductibles (which are far too expensive) and are far less likely to visit the hospital for unnecessary treatment.
8
The vast majority of people do not consider at trip to the ER anything but misery. I was there for hours when my daughter broke her leg.
There may be a small number of "frequent flyers" who abuse the system, but they aren't going to increase if hospitals were free any more than people would free view colonoscopies as right up there with free massages.
13
Really - do tell - I have "free" medical care and all I've done is go for a required physical. By your logic I would be going to doctors all the time to cash in on my freebee cause with free medical I obviously have nothing better to do. Such assumptions and so rude.
7
Shea--just how do you think someone unemployed with no health insurance is going to afford to see a primary care doctor instead of the ER? Someone with insurance will see their doctor when they have a cold or stubbed toe or headache and insurance will pick up the tab--or much of it. They are, in essence, getting something for "free" because they are not paying the full freight, especially if they have decent employer-paid healthcare. Who do you think you're kidding?
Btw, those with insurance are more likely to visit a primary care doctor if they have a concern. That's called preventive care--catching a potential large problem (like early stage cancer, etc.) and getting it taken care of before it balloons to an unmanageable (and expensive) health problem. What happens, for example, if that headache which won't go away is really a tumor? What if you have a lump in your breast--but don't see anyone for a mammogram because the ER won't do that sort of thing (not an emergency for them)?
Who do you think ultimately picks up the tabs when these problems are not solved--the taxpayers--someone has to pay, so society pays no matter what--usually for large hospital bills for the poor who have no insurance and who still get sick.
4
Sadly, education or "awareness" alone does not work. We have known for years that people need to exercise, eat a healthy diet, don't smoke, don't have guns in the house, don't abuse drugs or alcohol, drive responsibly, wear a seat belt, take their medications, get vaccinated etc.....but people still don't/do them.
The only thing to do is make the bad things expensive and inconvenient, and the good things easy and very accessible.
Both take resources, and too many people, unlike in other
more progressive countries with much better health outcomes, don't want to fund such efforts.
6
One of the issues that we have in the US is the difference between 'acute' patients and 'chronic' ones. Acute conditions tend to get sympathy, empathy, less finger-pointing, etc.
Those of us with chronic conditions are long used to being told our problems are our own fault, that if we just did X, Y, or Z all our issues would go away. We're used to being told that it's just a matter of eating properly and taking turmeric and that if we really, REALLY wanted to, we could improve.
Life doesn't work that way. I have chronic conditions that are incurable but not terminal. I spend thousands of dollars every year on medical treatment, including things my insurance won't pay for. Enough with the finger-pointing, please. I get enough of that just for daring to be disabled.
42
Yes, adults need to take most of the responsibility for their health care--except those disabled in a manner which prevents them from adequately considering their needs and responsibilities.
"Health care" means caring for your health, learning what types of behaviors and actions are necessary in order to develop good health and remain in good health--or better yet, flourishing.
However, as the positive psychology/positive health/positive education movement has pointed out, in the United States, we don't have a "health care system": we have what amounts to an almost totally focused "illness and disease care system."
Our schools, primary care, and dominant culture do not maintain an active education and intervention system to promote the activities and awareness which maintain "well-being," a comprehensive set of human needs. Promoting "well-being" is what the primary function of a health care system would be, if we actually had a health care system.
So, yes, please take individual responsibility. But until our nation and government wake up, we still lack a "health care system," and, instead waste billions or even trillions on the world's most expensive "illness and disease care system," while our national longevity declines, in contrast to the rest of the Western world.
"Fault" and "blame" are dysfunctional behaviors--perhaps even atavistic--which allow the focus to still remain blind to what is actually needed. Finger pointing still doesn't get us what needs to be done.
2
Genetics play such a large factor. I was not obese...really just a few pounds heavier than I should be(and was actually quite active ... life long runner) when I became diabetic. My father was diabetic (although I didn't know it until much later, I didn't grow up with him) as well as his father. I struggle to maintain my numbers while I watch others eat to their hearts content. I certainly don't need a lecture from anyone.
My philosophy has always been that you take care of yourself to the best of your ability and you also give back to society, which has provide you with an opportunity to flourish. You don't judge others, because you don't really know them or the factors that affect their lives.
24
"A RAND study found that making people pay more for care does reduce how much they use, but that they cut out both highly effective and marginally effective services."
There. in a nutshell, is why copays, deductibles, "skin in the game" doesn't work in a healthcare system. Will someone explain this to the republicans ?
26
The whole "personal responsibility" meme is an exercise in victim-blaming. People don't generally get sick or hurt on purpose. It's possible to be slim and fit and still get sleep apnea. It's possible for a non-smoker to get lung cancer, or for a careful and alert pedestrian to get hit by a drunk driver. There's also a huge element of poverty-shaming present, since entirely too many Americans can afford only cheap and unhealthful food. And a lot of chronic conditions, like diabetes and asthma, can become much worse without access to affordable, ongoing medical care that mitigates their risks.
We should consider public health one of the most important parts of our infrastructure. A child whose asthma is well-controlled is a child who misses less school, and whose parents miss less work. A smoker who regularly receives nonjudgmental but strong advice from a physician may be more motivated to quit. And insuring everyone is going to be a lot cheaper for taxpayers than the costs of preventable disabilities and premature deaths.
71
Its interesting that the GOP wants increased personal responsibility, yet many of the public policies passed support companies that encourage unhealthy behavior. Look how cheap junk food is because of subsidized ingredients. Why don't they put those subsidies towards fresh fruits and vegetables.
Why did there have to be a case against ads for tobacco near schools. Isn't that obvious that industries like tobacco and alcohol shouldn't be allowed anywhere near children.
Schools have cut out PE so children don't learn the importance of exercise. Now the govt wants to cut funds to the national parks.
Workers are underpaid so how do they afford a healthy lifestyle? Yesterday on NPR there was a segment about how you would have to work 3 FT minimum wage jobs to afford a 2 bedroom apartment in most cities in the US.
And then there's air pollutions which also causes health issues - which none of us can do anything about that.
Last year when there was a vote to label GMO foods it didn't pass Congress because these same personal responsibility people didn't think GMO foods needed to be labeled because it would be an undue burden and increase in cost to the food.
We can't take personal responsibility when all of the facts are not shared with us and when policies undermine healthy behavior.
When is the GOP going to take responsibility for their behavior?
26
Rather than make an argument as the author did at the end of the article that goes like, "we are a rich country and we can afford health care for everyone", I would rather we make the argument more alone the line of "a healthy nation depends on the health of all its citizens".
Even health care given as charity in hospital emergency rooms gets paid for by the rest of us through higher costs.
Otherwise we are acknowledging that some humans are both expendable and replaceable and thus don't deserve the cost of health care.
Perhaps what we need is a real alien invasion of the outer space sort to make us realize that there is only one species of humans on this planet...
3
Yes, we should all do what we can to be healthy but that is easier for some than others. The poor can't go to the gym or buy organic food or reduce stress with vacations and nights out. Without insurance they can't even get regular preventive medical check-ups, or maybe even a flu shot. So if Republicans want Americans to take responsibility, they can make it happen by voting for programs that enable the poor and the middle class to help themselves. Since they are doing the opposite of that, I say they are responsible for the poor health of anyone earning a minimum wage or is below the poverty line. Until the GOP wants every American to have a sustainable wage, they have no right to accuse people of not doing enough to help themselves.
16
**The poor can't go to the gym or buy organic food or reduce stress with vacations and nights out**
This sounds like born privilege talking. You don't need to eat organic (or expensive) to eat healthfully and you certainly do not need to belong to a gym in order to exercise. This is a matter of information (which is out there free) and choices. That's where people fall down. They have the information. They choose to prioritize other things over being healthy.
2
Eating properly requires adequate money and the time and access to decent markets plus the time and physical access to cooking facilities. I do not know about now but in the past Vancouver has had community kitchens.
1
Sounds good, but what would result in the desired outcomes? Would increasing premiums, or higher deductibles, or higher co-pays for nicotine addicts cause them to change their behaviour? Would any of the above stop people from becoming addicts in the first place? Would Big-Tobacco allow their bought and paid for politicians support such policies?
The profits and executive bonuses of many US Corporations depends on poor lifestyle choices. That is a fact.
13
Certainly we all have some degree of control over what we eat, how much we exercise etc. and therefore a degree of control over our health. One question I have, however, is what percentage of our health is based on these "lifestyle choices," and what part is contributed from the environment. Do advocates for personal responsiblilty also advocate corporate and political responsibility for the poor quality of the air we breath and the water we drink? I didn't think so.
15
The health care industry should instead lower premiums for those who don't use the system. That way, good outcomes are rewarded, and bad outcomes are not punished, but considered the norm.
2
Personal responsibility sounds like a nice and simple catch phrase but the causation of medical need doesn't even come close to correlating with personal responsibility and short of showing direct correlation, it is merely hollow words spoken by someone lacking understanding of medical need. Here are a few points to drive it home:
1) What personal responsibility should a two month old newborn with a defective heart valve have done differently in utero to prevent the need for surgery and possibly a life time need to be on some medication or need additional surgeries in the future?
2) What personal responsibility should a shooting victim who was at a Las Vegas concert have taken. Is it their fault for getting shot by a millionaire?
3) What personal responsibility should patients with cancer who can pin point the problems back to unprotected X-ray scanning when they were prenatal and the AMA and the X-ray manufacturers in the 50s and 60s said it was safe (which they already knew it wasn't)?
4) What personal responsibility should the residents of Flint, Michigan have for drinking tainted water (something the current EPA has just increased the odds of happening again with an ease on leaks into rivers and streams)?
The US already has a private organisation trying to determine fault. It is called the insurance companies and frankly the results result in more expensive healthcare, shorter life expectancy, and reduced quality of life. Whose fault is that?
55
This is an important discussion. But it's complex. Many people who "take good care" of themselves have serious health problems and others seem to survive risky behavior just fine. It's reductive and punitive to blame people but perhaps it's helpful to encourage people and to provide comprehensive healthcare across the board.
8
Personal responsibility, with the help of positive genetics , certainly leads to good health! Just like I have no doubt, that the primary reason lots of people in America are fat, circa 2017, is because they eat too much, and are hoodwinked by a slick advertising component of the food industry!
4
There is luck one cannot control, there is the unknown one cannot control even if s/he wants to, and there is something one can do. If you read the comments to the other health-related articles, however, the claim is not only that every disease is caused by being fat but also that being fat is a result of irresponsible eating/lifestyles. To be fair, NYT reports make exceptions to that claim. About children, moms are to be blamed for no-breastfeeding or somehow making their children fat. About the fast food industry, they are responsible for making everyone fat even though they don't give that food free.
3
The lovely unidentified photo shows yoga practitioners on the beach platform of the Sivananda ashram on Paradise Island, Nassau, Bahamas. Sivananda teaches mind and body health through exercise, breathing, relaxation, diet and meditation. The ashram experience is a marvelous awakening, for those who are able to go.
4
yes, just the place where a single mother with 3 jobs, living in the projects should aim for on her one day a month off.
can we please start with some basic steps for enabling collective good health? how about allowance for sick days off, food accessibility and prices to incentivize healthy choices, walkable safe city neighborhoods and free preventative health care clinics?
I say this as a yoga practitioner myself, let's not worry about the lululemon-wearing yogis, they are if nothing else, all about self-care.
20
JA--so true! I have a wealthy older relative who has never had a job; she swears by the "stress relief" she gets from her weekly massage.
Yes we are. But many because we do have health issues.
85% of beneficiaries refused to keep their appointments or take their medications? They're lucky they got to keep any benefits at all. It's liberal nonsense to say charity should come without strings. I give up freedom from 8am to 6pm to hold a job that gives me health insurance. Shouldn't someone who gets free insurance be willing to give something up for it in return?
6
But you also get that health insurance tax free. This is a hold over from WWII when wage freezes encouraged employers to give health insurance as an addition to salaries that were frozen.
Maybe we should start with a little tax reform and tax the whole package of wage and benefits. Bet that would put a dent in the money needed to give health care to those who don't get it through their employer or who don't have jobs...
6
People on Medicaid are poor enough that they don't have reliable transportation. Some are impaired to the point they don't recognize a need for follow up or preventative appointments.
It's not the same as me or you, presumably, blowing off an appointment, there are a lot of factors.
The best solution might be more of a walk-in clinic approach where an exact time is not required.
1
How about sports injuries? Aren't those caused by people engaging in unnecessary, risky behavior? Stupid accidents, like falling off the roof--no coverage. Wrecks while intoxicated? Don't pay for the driver. People who don't get immunizations--don't pay for measles or chicken pox. If we are going to judge fat people for poor decisions, let's judge everyone.
88
Maddie, that's right, the medical costs of "wild living" would pay for 50% of the PPACA.
When is Bernie Sanders going to start lecturing about that?
1
I sit at home, and don't always eat right (although I am not diabetic) because I am old, crippled, and can't get out. Mulvaney should come right out and say what he thinks: Old people, sick people, and poor people should lie down and die and decrease the surplus population. It is what the GOP has in mind for the future.
92
You should read Philip K Dicks short story on the subject of what to do with excess humanity. Hollywood made a movie about it called "Soylent Green". Maybe that's their plan!
3
Soylent Green is based on Harry Harrison's story "Make room! Make room!"
America is the "poster child" for the description of a "meritocracy", winners and losers, no gray areas and if you are a loser, it is your fault and that includes if you get sick and need care. It would seem those that think that way have what has never existed before in human history "a lease on life". How fortunate for them.
The author of the article does give a snapshot of attitudes in this area from those, especially politicians, whom, when it comes to healthcare for themselves and their family, it will never be a worry. There is, however, one major flaw in the authors claim of increased lifespan in America. It was recently reported that because of the massive drug/opioid crisis and significant increased stress in the workplace, the average lifespan in the country has now peaked and is actually in decline.
Clearly now, with the forthcoming hatchet job to medicare, medicaid and social security, that average lifespan is guaranteed to decline even faster.
8
What happens if you are someone who acts in the most responsible way possible when it comes to her health and yet you still get sick? It's all well and good to say that people should be responsible about taking care of themselves but even "healthy" people get sick since genetic and environmental factors can play a significant role. Demonizing someone for not having the right genes is never going to solve our country's systemic health care woes.
59
Exactly. And if you are already poor, you are more likely to become sick because of limited access to affordable healthful foods or to gyms. Limited time to "work out," and the stress of constantly worrying about money also causes illness. Blaming the poor for being irresponsible seems like piling on. (And yes, I acknowledge that smoking is a choice).
19
Then you are not one of the people paying the higher premiums or having your medical benefits reduced. The whole concept of personal responsibility in health care is that those who act responsibly will get lower cost health care, while those whose actions lead to their ill health pay more.
1
Why are Republicans all about personal responsibility, but against requiring that all have insurance? I would think that one being responsible for their own health care costs us the ultimate in personal responsibility
67
Because those of us against the individual mandate do not believe that the government should force people to behave responsibly, but should reward those who do. Just as it should not be the government's job to force you to quit smoking, neither should it be their job to force you to buy insurance. If you do not do either one, you pay the penalty for your irresponsible behavior.
3
The thought is that if you elect to not have health insurance, are you also going to agree not to show up at the emergency room and expect free or subsidized care?
Facing death and or disability, you might have a different attitude.
Why should the Government reward but not punish? Seems to me reward and punishment is two sides of the same coin.
3
It’s never acceptable to live an unhealthy life. The only reason the rich can do so and still be covered is because they waste their own money, not taxpayers, compensating for their poor health.
If you’re a millionaire, go ahead - get multiple liver transplants - who am I to tell you how to spend your money? If you’re poor, I want some reasoning and evidence as to why you deserve the funds for a liver transplant over all the other people suffering and dying for a variety of reasons in the world.
5
So, Johnny, what happens if you need that liver transplant and can't afford it? Why should good health care be reserved for the wealthy? They get everything in life already because they're rich(whether they worked for it or inherited the dough.)What about the other 99%?.
And taking personal responsibility for your health care was at the heart of the ACA's individual mandate.
21
You can't legislate common sense. My father was a terrible patient - overweight, terrible eating habits, zero exercise, and he was a frequent user of the system and had terrible health issues, many of which could have been avoided if he had taken care of himself. This is a cultural issue. Americans want to sit on the couch, click the remote and eat chips.
9
If one agrees with Mulvaney's statement, “That doesn’t mean we should take care of the person who sits at home, eats poorly, and gets diabetes", would that apply to that man in the White House should he contract diabetes?
38
We shouldn't pay for their healthcare.
1
Health education plays a critical role in reducing the nations healthcare cost. Having better information about nutrition and lifestyle is important, and the value of up to date vaccination; but it is also advantageous to know when to seek medical care, what questions to ask your doctor, how to take medication, and a host of other health related issues. In the end, no one has a greater vested interest in your health than you do.
Health education is good, but it is not a substitute for a healthcare system where people can find accurate information without being afraid of exorbitant (inflated costs).
You do realize that in the rest of the developed world patients don't have to play this game of "I wonder how serious my symptoms are - let me just google them to see if it's worth the expense of visiting the Dr / Urgent care / ER". This only happens in America.
13
Some of the energy of this idea of personal responsibility is the residue of idiocy like the Law of Attraction/The Secret/Landmark Forum/est that has migrated into pop self-help.
12
The idea of personal responsibility dates back to Aristotle and earlier. It is also the foundation of Western civilization. It is how we craft laws, constitutions, and other social conventions... so I think 'idiocy' might be over-selling it.
5
God it must suck to be poor in this country. So much for the old Republican ideal of less government interference in our lives.
19
Fundamental questions need to be asked: why do people drink too much, smoke too much, eat badly, etc.? Putative measures will probably show no positive results, and no wonder... People are overworked, underpaid, underappreciated, see that their kids will probably be worse off than they will, and feel pretty helpless in their lives. Until we start to address treating human beings like human beings again, with dignity, fair pay, equality, etc. we're most likely going to see poor behavioral choices. Punishing children whose parents don't follow certain prescribed "wellness" rules? Really? Is that what our society has come to? Yes, unfortunately it has. And that's where the sickness truly lies.
I didn't start to see how crazy this all was until I lived in another country. Here in Germany, people just go to the doctor when they are sick. That's it. They don't have to decide whether it's a true emergency or not (how can we think to punish people if it's not a "real" emergency? The stupidity of that (assuming people can diagnose themselves along the lines of a real doctor) is galling.)
I used to put off doctor's appointments starting in September if I hadn't met my deductible in the US, so that I could "start over" in January. Just that is fundamentally screwed up.
Just the stress of worrying about how to manage health care costs in the US probably causes more people to get sick than a lot of other factors. We know that stress = sickness, eventually.
157
Agree completely! In the USA if one doesn't make enough money to live well, it's entirely their fault, no matter how many jobs they hold or if they have an illness inherited from the family genome....ah, the land of the rugged individual!
39
Treating people with respect doesn't put a penny into the pockets of the rich, so you can forget it. We are a capitalist country. We worship money. Make the rich richer, or get out of the way.
7
"Vice President Mike Pence has argued for “bringing freedom and individual responsibility back to American health care.”"
Right-wing trope alert: this does not mean what the author seems to think it means. It's a message to insurers and big health care provider corporations that help is on the way -- for them.
57
The United States is not that wealthy as this article states, because no USA Citizen has their basic human rights yet, they are not born that way. Each baby is born without their basic human rights. So, until the set-up is correct, we all live in a sickening environment, from birth. Not sure who is responsible for this extremely illegal mess. ----- So, as for ranking reputations of Countries... the USA is not wealthy. Wealth, includes basic human rights of food, shelter, protection from crime and violence, clothing, reasonable intelligent education.
13
Unfortunately, Kim, when three-quarters of the citizens in America have never owned a passport and, of course, never had the opportunity to travel outside of their own country, they will continue to buy in to the outdated notion of "America being exceptional and the greatest". That may be the case if you are very rich, but, the rest of the population, not so much. In all the categories you describe lacking in America now, compared to much of the rest of the western industrialized nations in the world, on a list of comparisons, in several respects, America is sinking fast, in some areas that would easily qualify as "third world" or worse.
7
Here's is the bottom line here guys imo.
I am by no means an expert on health care so I won't post a lengthy detailed diatribe on what should be done re this subject.
However what I do know is that almost all our peer countries have universal, quality, affordable health care and we do not.
Many of these countries have better health stats then we do, ie longer life spans, lower infant mortality etc.
It doesn't take a rocket scientist to realize just about any one of these countries health policy is better than ours.
We just have to pick one or a combo.
117
" .. However what I do know is that almost all our peer countries have universal, quality, affordable health care and we do not."
Fact: Vermont and Colorado have rejected single-payer. And it is stalled in California.
Ignoring facts will not pass legislation. Gripping reality might.
1
Thank you for your reply Bing. I did not say single payer is the best. Many of our peer countries do not have it but have affordable, universal, quality health care. Some countries and some states have it and are happy, others prefer another way.
The bottom line is our national health care system is more like a third world country than a modern country.
The idea that we should cover health care or its cost based on assigning proportional blame is highly problematic. We’ve taken Home Economics out of the curriculum. Nutrition is no longer taught, barely even in medical school. The food industry’s ubiquitous high fructose corn syrup is processed totally in the liver and causes most of the conditions that alcohol causes, such as hypertension and increased susceptibility to Type 2 diabetes. What about the ‘fat makes you fat’ movement a couple of decades ago? The governmental buried evidence that sugar promotes inflammation and contributes to heart disease? The eggs are good...no they’re bad...wait, new evidence shows they’re not contributory to high cholesterol. But now we are not sure that cholesterol is that important.
I happen to think skiing is a dangerous sport; should we assign blame and deny coverage to those who break their leg in a skiing accident? What about people who injure themselves on slippery winter roads or sidewalks when the weather officials recommend that people to stay home? They knew what they were getting into.
Do we really want to deny coverage for people that don’t take every medicine prescribed? If you’re scared of the side effects it’s your right to weigh the possible consequences and make a decision. Neither the government nor insurance companies should have the right to coerce you into taking medicine you’re scared of.
No one will have health care coverage if we go down this slippery slope.
102
Carrot and stick problem writ large. I would propose what a local health cooperative did some 4 decades ago that worked. I had my health insurance with the coop. Everyone paid their insurance premium at the start of the year and everyone paid the same. Everyone got a free physical every year. At the end of the year, they reviewed all the records of your use of the health care system as well as your results from your annual physical. Those that used less health services and either maintained their health or improved it got a rebate on their premium from the previous year. The less you went to the doctor for every little sniffle or the efforts you made to improve your own health paid you money for doing so. The unintended consequence was the first annual physical would often find unexpected problems that were chronic and treatable, saving lots of money in the future. Simple isn't it? It is what the ACA should have been but was not. BTW, that coop is still in business, still profitable most years, and still creating a healthier client base.
12
I don't agree with punishing people for getting sick. Or rewarding people for not getting sick. That is very most often not a choice. I rarely am sick. Also, do you really want to discourage people from seeking medical care? Little things can start off as big things.
8
How would encouraging taking care of your health discourage people from seeking help?
That doesn't reward people for being well. That rewards people for NOT seeking medical care.
14