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#2 CLAIM: People do not take responsibility for their own health. If people just lost weight, stopped smoking, and listened to their doctor health care costs would go down.

TRUE

It would help if people took better care of themselves. = TRUE

An ounce of prevention is worth a pound of cure.
Take, for example, the current epidemic of obesity in this country. There are many different types and cause of obesity, some are glandular, some are hereditary, some due to over-eating or misguided food habits. Here’s what we know for sure:

  • Recent research suggests that poor eating habits and lack of exercise lead to obesity, which can lead to other expensive conditions such as type 2 diabetes, high blood pressure, heart disease, joint problems, and raises the risk of developing 20 different kinds of cancer.
  • According to the American Diabetes Association, the nation’s diabetes epidemic costs us $174 billion in 2007. (This is as much as the conflicts in Iraq, Afghanistan and the global war on terrorism combined. More than the $150 billion in damage caused by Hurricane Katrina.) This is a 32% increase since 2002. There are 1 million new diabetes cases a year.
  • Obesity has doubled in the past 30 years, during which time there has been a 30% increase in overall health-care costs. Obesity and conditions arising from being overweight contribute nearly $100 billion to the nation’s medical bill, as of 2003.

Though not all obesity is caused by misbehavior, and not all cost increases are caused by obesity-related disease, it couldn’t hurt for Americans to find ways to eat better, spend less time on the couch, and help our children do the same.

The truth is there is only so much a doctor can do to keep you from getting sick – especially since most people don’t go see their doctors until they’re already having some kind of symptoms.

Very few people do EVERYTHING they’re supposed to do to take care of themselves. Do you? Think of all the opportunities you have to make unhealthy choices:

  • when you don’t get enough sleep or skip meals in order to meet a deadline
  • when you grab some fast food because it’s just so convenient
  • when you drink too much at a party
  • when you skip your exercise regimen
  • when you grab that free donut at the office or get the extra-large “bargain” snack combo at the movies
  • when you have the occasional cigarette

Some of our bad choices have become normalized in this era of rapid medical advances. For instance, does the person who can now take a statin to lower their cholesterol have less incentive to exercise and eat right? Does the surgeon who gets paid by the insurance companies for performing surgery really do their best to use surgery as a last result?

Data shows that the use of medicines needed to combat obesity and lack of exercise is rising most rapidly among young adults age 20-44. The use of cholesterol-lowering drugs in this group, though relatively low, jumped 68% between 2001 and 2006. Use of blood-pressure medicines increased 21%.

SIDEBAR: Most Popular Prescriptions in 2004
Drug Function Rank in Spending Amount Spent In Purchasing
Lipitor Lowers cholesterol 1 among U.S. adults $9.23 billion
Zocor Lowers cholesterol 2 among U.S. adults $4.7 billion
Nexium Treats gastric reflux 3 among U.S. adults $4.13 billion
Prevacid Treats gastric reflux 4 among U.S. adults $2.42 billion
Zoloft Antidepressant 5 among U.S. adults $1.9 billion
Singulair Anti-asthma 1 among U.S. children $.68 billion
Concerta Treats ADD 2 among U.S. children $.49 billion
Strattera Treats ADD 3 among U.S. children $.43 billion
Zyrtec Antihistamine 4 among U.S. children $.42 billion
Adderall Treats ADD 5 among U.S. children $.41 billion


What about this claim that we’re relying on our health care system to take care of things that we should be doing ourselves? Are we really over-using doctors and tests for things that more vitamins and sit-ups could handle? How much of health care spending is due to people wastefully going to doctors and getting tests without any care about the cost?

People are getting too much care. = FALSE

Healthy behaviors exist on a spectrum. Surely there are people at the “bad” end of the spectrum that are increasing their health risks. But this leads to a few questions:
1) Do even the people who take the “best” care of themselves NEVER get sick?
2) Are those on the worse end of the spectrum hurting their health intentionally or out of ignorance or convenience?

  • People not taking their medicines as prescribed could be costing the nation as much as $177 billion in medical billsand lost productivity per year, and failure to take medicine is associated with up to 40% of nursing home admissions.
  • Poor communication between doctors, pharmacies and patients have been identified as part of the reason for poor treatment adherence – people not taking their medicines as prescribed. Patients don’t know how to deal with the discomfort of side effects and don’t know that going off their meds too soon can be hazardous. And while you might assume education or income would influence this, no well-designed study has ever found that to be the case.

3) How much does individual behavior contribute to poor health and increasing costs compared with, say, genetics or environmental factors like pollution? When something as mundane and widespread as night-time lights can be linked to breast cancer, how are we as individuals to blame?

The research organization RAND has found that U.S. adults receive only 55% of recommended care.

  • Fewer than half of diabetics have their blood sugar levels measured regularly
  • Just 45% of heart attack patients get medications that could reduce their risk of death
  • Fewer than 2/3 of elderly Americans are vaccinated against pneumonia
  • Only 38% of elderly adults are screened for colorectal cancer
  • Even with basic illnesses like pneumonia and problems like high blood pressure, patients only received 39% and 65% of recommended care respectively

Why is this happening? In part because people are not getting the education needed to make sure they fully understand the best way to manage their health problems. In part because our primary care system doesn’t allow doctors the time and resources to know the ins and outs of all their patients and stay on top of them. We’ve come a long way, baby, from the days of doctors who made home visits – doctors who knew you from the time you were born.

The idea that people get too much health care because they just don’t care about cost is used to support Health Savings Accounts (include link) and Consumer-Directed Health Plans, which shift the cost of health care from business to individuals. In fact, this attempt at “cost-saving” works – people with HSAs get less care, but it does not address the costs in the system.

BOTTOM LINE

Is illness our “fault” or a fact of life of being human in an industrial age? The real problem is not people getting too much care but people not getting the right care. Not getting enough of the right kind of care actually creates more costs.