I was a mile into a recent treadmill workout when coverage began to air of President Obama's healthcare forum at the White House. As I watched, I found myself gradually gaining speed, growing more and more upset.
His plan to provide affordable, accessible healthcare for all Americans is strikingly flawed. It demands fundamental change from insurance companies, hospitals and healthcare providers -- and fails to address what healthcare consumers themselves should do.
During Obama's campaign, the soon-to-be president spoke frequently of sacrifice and self-responsibility. When it comes to healthcare, however, he's failing to hold people accountable for their own unhealthful behaviors and the overwhelming financial effect they have. He needs to insist that everyone play a part in solving our national healthcare crisis.
Although people frequently perceive ill health as something that happens to them, they're often responsible for making themselves sick.
The most obvious example is smoking. Smoking dramatically increases the risk of cancer, heart disease and stroke (along with a number of other diseases), and is the leading cause of preventable disease and death in the United States. Despite the known risks, more than 40 million Americans light up every day.
Bad habits
Smoking is just the tip of the iceberg. Americans indulge in a host of unhealthful activities irrespective of their effect on health. Overeating has practically become a national pastime, and the percentage of people who are overweight or obese has soared to more than 60%. Being overweight not only increases the risk of heart disease, stroke and diabetes, but also osteoarthritis, gallbladder disease and endometrial, breast and colon cancer.
We not only eat too much, we eat all the wrong things. Fewer than 25% of adults consume the recommended five servings of fruits and vegetables each day, and fewer than half of children get adequate amounts of calcium in their diet. Soda has emerged as our national drink; recent surveys estimate that roughly 40% of young children and more than 60% of adults drink soda each day. These sugary drinks provide little nutritional benefit, and studies suggest that they lead to unintentional weight gain, increase the risk of diabetes and undermine bone strength.
We live sedentary lives. According to statistics maintained by the Department of Labor, men and women in the U.S. spend between two and three hours each day watching television and less than 20 minutes participating in sports and exercise. And, too often, we refuse to take even simple steps to keep ourselves healthy and safe. We go without bicycle helmets, drive under the influence of alcohol, carry weapons and ignore warnings about the consequences of unprotected sex; we fail to get important health screenings, opt out of recommended immunizations and neglect to take prescribed medications.
Americans are paying dearly for their bad choices -- both in lives and dollars. According to the federal Centers for Disease Control and Prevention, medical expenditures associated with being overweight or obese may exceed $78 billion annually. For smoking, the numbers are thought to approach $75 billion each year.
Inactivity is estimated to cost us an additional $24 billion, according to a Harvard University study published in 1999. Sexually transmitted diseases run more than $8 billion a year, according to the Kaiser Family Foundation. Drug-use costs roughly $15 billion, says the Office of National Drug Control Policy; and alcohol abuse $26 billion, says the National Institute on Alcohol Abuse and Alcoholism.
Keep in mind, these numbers represent only medical costs; when you look at the total economic burden the unhealthful behaviors impose on society, the numbers are much, much larger. Expenditures related to drug abuse, for example, soar to more than $160 billion when productivity losses and criminal justice system costs are considered.
Hard to change
Holding people personally responsible for their behavior isn't a popular position. It's often perceived as blaming the victim. Daniel Wikler, professor of ethics and population health at the Harvard School of Public Health, believes that for many people bad habits are simply hard -- if not impossible -- to break. "They want to change, but just can't seem to do it," Wikler says.
He points out that with addictive habits such as smoking, the battle can be particularly difficult because nicotine keeps smokers coming back for more. "For a lot of people, smoking isn't a treat, it's simply a way of getting withdrawal symptoms to go away," Wikler says.
