Healthcare Costs and Personal Responsibility
I am one of the 35% of Americans who are obese. I am also acutely aware of the impending financial crisis facing our increasingly arcane and expensive system of healthcare delivery and finance. Innovative ideas abound regarding the chaos that is healthcare finance, but, unfortunately, there is no apparent national will to achieve consensus and drive change, whether evolutionary or revolutionary.
One of the key issues that arises in any discussion of healthcare cost is the role of personal responsibility.
Why should society be asked to cover the cost of a person whose unwillingness to control what they eat, drink, inhale or inject leads to heart disease, cancer, diabetes, accident injuries, overdose or HIV? The prevailing opinion is that society should not be asked to pay to treat illness generated by one’s own choice of unhealthy behaviors. Limited healthcare dollars should be used for those suffering from birth defects, accidents or acquired illness.
One can distill the myriad rampant theories on food, tobacco, alcohol and drug addiction down to two.
Personal responsibility as expressed in Nancy Reagan’s "Just Say No" campaign: the individual is personally accountable for what he or she puts in their bodies and may choose to stop at any time.
Or, the disease concept, which adheres to the idea that there are certain inherent addictive aspects of food, cigarettes, alcohol, and drugs often beyond the power of the individual’s will to overcome them, and that medical intervention may be appropriate.
It is worth trying to understand the disease concept of addiction before writing off a huge segment of society as not having the self-discipline and fortitude to control their ingestive behaviors. Food, smoking, alcohol and drug addiction have both psychological and biochemical addictive elements. The tenacity of their addictive qualities may depend on the ethnicity or genetic inheritance of the sufferer.
The recent Prairie Home Companion marquis joke from their annual joke show is illustrative. "A single woman goes home looks in the fridge and goes to bed. A married woman goes home, looks in the bed and goes to the fridge." Food alcohol and drugs are, to varying degrees, anodynes that suppress the dynamic range of feeling. They provide effective short-term palliative relief from the pain, and joy, of everyday life. After that relief, they are followed both by the return of ambient pain and additional biochemical effects that intensify that pain, a "sugar low", hangover or withdrawal. These downs induce a strong desire to re-medicate either with refined carbohydrates such as starches and sugars, alcohol, tobacco or drugs of choice including blue-chip pharmaceuticals.
Everyone is different. There are those for whom there is little in the way of a biochemical effect and thus they never use, or the effect may be there, but they may have not developed or been exposed to addictive patterns of use. Certain races are more prone to use because of their biochemical sensitivities. Native American tribes have long battled alcohol use. Pima Indians and Polynesians have long fought obesity as they tried to assimilate new food sources. The English broke the spirit of the Chinese in the 19th century with opium.
Before we simply write half the nation out of the healthcare system, we must better understand addictive behavior. As one who has battled obesity since the age of eight and tried to manage a love- hate relationship with food, I would urge us to understand the addictions to which half of America is prey and try to integrate cost-effective treatment programs into our educational and healthcare systems.
The rise in adult onset diabetes in Hispanic teens, the ubiquitous availability and use of junk food and drugs in America and the social damage wrought by alcohol all warrant our attention both in educational, regulatory and healthcare systems.
Bill Schubart currently weighs 350 lbs and is on the South Beach Diet this week.
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