Politicians, journalists, and health policy experts talk on and on about the huge costs of health reform, raising taxes, a public option to compete with private insurers, reducing administrative costs, introducing electronic medical records, conducting more research to compare treatment outcomes, etc.
While each of these topics is important, the current discourse misses an essential point - it is the responsibility of everyone to adopt healthy lifestyle behaviors that will improve personal health. It is within the power of each American to help reduce costs and thus make health insurance affordable.
Exhibit I (Click to view) tells a grim story. Not only did health spending average $7868 per person in 2008, but additional data from the Kaiser Family Foundation shows that family health insurance premiums have nearly doubled from 2000 to 2008. The average family health insurance policy now costs in excess of $12,500 per year. Not only does the U.S. spend twice as much as other industrialized nations on health care, U.S. citizens are in overall worse health than those of most other nations. In the U.S., many families spend more on health care than they do on housing or food. In 2008, 17% of Gross Domestic Product (GDP) was spent on medical care. Even so, about 45.7 million people are without health coverage and millions more are inadequately covered. Illness is the leading cause of personal bankruptcy in the U.S.
According to the Centers for Disease Control and Prevention (CDC) leading illnesses that drive these costs are heart disease (#1 killer), cancer (#2 killer), stroke (#3 killer) and diabetes (#6 killer). Each of these diseases can be substantially reduced with major lifestyle improvements.
Without a focus on prevention, any health reform we adopt will fail to get costs under control. President Obama understands this. In his recent speech to the American Medical Association he said:
"The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children."
The President doesn't go far enough. Here are some of the ingredients that should be included in national health reform:
An aggressive public education program that communicates, especially to our children, the substantial health risks of a poor diet, inadequate sleep, too much stress, and lack of exercise. Just as the government adopted an anti-smoking initiative that has substantially reduced smoking in the U.S., we should now turn our attention to the health risks of unhealthy food and beverages. After all, a poor diet is actually a worse health risk than smoking.
A rewards program that provides reductions in health insurance premiums for those who adopt healthy lifestyles and whose main health risk indicators remain positive - Not only will people save on health insurance, but physicians who work with their patients to improve their lifestyles and their health will receive bonuses. Schools that improve lunch programs will receive additional financial support and businesses that promote healthy behavior among their employees will see substantial reductions in their employee health benefits costs.
A reorientation of physician education and medical practice that provides incentives for medical students to pursue careers in primary care - Medical schools will be given financial incentives to introduce lifestyle training (including nutrition training) into medical education. Physicians will be trained to use drugs and surgery only as a last resort after more conservative non-invasive (often lifestyle) approaches have been tried. Medical practice will evolve to a point where physicians will only use treatments with proven beneficial health outcomes.
An aggressive national food policy - As politically unpopular as it will be, government farm subsidy programs will be reoriented to reward farmers and food distributors based upon the health benefits of their products. Incentives will be provided to supply only healthy food choices to our school lunch programs. Incentives will be given to produce and distribute healthy food locally, not only improving health, but also reducing the environment costs of factory farming and long distance food distribution.
This is only a partial list. Each of us needs to do our part by taking our own health seriously. We can vote to reduce personal and national costs and improve our health with our knives and forks, our walking shoes, our sleep habits, and a more conservative use of the health care system.