In Practice

A maintenance guide for health insurance

We're all in this health insurance pool together, one of the biggest reasons to hold ourselves accountable for risky behavior.

December 06, 2010|By Steve Dudley, Special to the Los Angeles Times

I like to call Thor the Lawnmower Man. He's a cheerful sort, always beaming from ear to ear, with laugh lines that convey a contented spirit. Even though he's 70, he sports a full head of amber hair. When I first met him, he needed a refill of his cholesterol and blood pressure pills. I said hello, introduced myself and proceeded to chat.

"I'm sorry if I'm yawning, doc. It's just that I was up last night til 1."

"I'm sorry to hear that. What were you doing till then?"

"Mowing the lawn," he said with a straight face.

"Didn't that bother the neighbors?"

"Naw! They don't complain! I work in a cemetery and they're all dead!" He broke out into guffaws of laughter before saying, "I gotcha on that one!"

By the calluses on his hands and the grime under his fingernails, I can tell that he is a hard worker. When I walk into the room, he assumes a pose like the Incredible Hulk and has me feel his biceps, like a buff teenager fresh from the gym. He takes the greatest pride in his rock-hard stomach — a visit never goes by without him asking me to take my best shot at it.

Thor tinkers with power tools, and he finally persuaded me to allow him to tune up my lawnmower. He completely disassembled the carburetor, cleaned it and put it back together. He also changed the air filter and pull cord, sharpened the blade and gave it a fresh coat of shiny red paint.

Then he gave me a little lecture on caring for my lawnmower.

"Doc, ya gotta take better care of this thing," he said. "The oil pan was almost bone dry, and the blade had some pretty bad nicks in it. There was dried grass under the frame. In the off-season you need to add a gasoline preservative so you don't gum up the carburetor."

I thanked him sheepishly.

The following spring, at one of his visits, he announced he would give my lawnmower its annual tuneup. Once again, I was treated to the very same lecture on lawnmower maintenance. I guess you would call me a non-compliant lawnmower owner.

I admit, I could do better. How hard would it be to wipe the grass out from under the cowling after I'm done with the lawn? If I paid attention, I could try to go around rocks rather than over them. Halfway through the summer, I could even check the oil. But it's just so hard to do all that. When I'm done with the lawn, I'd rather make a beeline to the fridge and reward myself with a frosty beverage than putter around the garage polishing my mower.

What does it matter anyway? It is my lawnmower, after all, not Thor's. But to hear him talk, I am personally insulting him when I don't follow his instructions.

The story would be a lot different if I were borrowing Thor's lawnmower — or if it were jointly owned by all the neighbors on the street. If I don't take proper care of something in which many others have a financial interest, then I'm being irresponsible.

Let's say one of my patients decides that his smoking, blood pressure and cholesterol issues are his and his alone. Fair enough. But then he develops massive chest pain as he's finishing off his limitless basket of fries at Red Robin. Now the sludge in his arteries requires heart bypass surgery and recovery time in the ICU. Who's footing the bill for that? It's a bigger picture now.

When we have insurance, we all need to maintain a certain degree of responsibility to the ones who are helping to foot the bill. Having health insurance is not like visiting the buffet line on the lido deck and saying, "I paid for my cruise, and now I can dig in all I want."

I insure my house. It is only reasonable for the insurance company to expect that I will lock my door when I leave and that I keep the place moderately well maintained. After all, if something goes wrong, they're on the hook (minus my deductible). If they find out that I leave the front door wide open all day, they have every right to either cancel my policy or bump up my rates to account for the higher risk I am asking them to assume with my careless behavior.

Perhaps this same principle should apply to health insurance, with personal responsibility being the expectation. People could get their checkups and follow the doctor's advice or run the risk of higher premiums and policy cancellations.

If that doesn't throw fuel on the flames of the healthcare debate, what will?

But think back to Thor and his lawnmowers. He gets upset with me if I don't treat my lawnmower as well as he'd like. I can only imagine what he would say if he were my doctor. I like to think I'm a better patient than a gardener.

Dudley is a Seattle physician.

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