Comments on: Is Personal Responsibility an Inconvenient Topic in the Health Care Reform Debate?

By: Really Really Good: Healthy Labourous Weekend! « Canhead

Really Really Good: Healthy Labourous Weekend! « Canhead — Sun, 06 Sep 2009 18:36:17 +0000

[...] “Seldom does anyone suggest how — or if — the individual’s role should be reformed,” argued Lisa Herrington, 46, a former health industry administrator who launched a discussion of the topic in May on the blog “Thoughts that Make You Think.” [...]

By: Juanita6

Juanita6 — Fri, 14 Aug 2009 22:19:04 +0000

The “pig in the python” is approaching Medicare. Let’s say that we are still debating this subject (and I do not consider shouting speakers down at town meetings “democratic debate), say, 10 years from now. By then we’ll have a large number of babyboomers on Medicare. Most will have purchased Medigap Plans. Medicare and Medigap (Medicare Supplements) — is this arrangement that not a blend of the government being a payor, with private carriers (by choice of the subscriber) handling part or all of the rest (depending on whether a non-mandated supplement was chosen)? Maybe we should extend Medicare coverage to everyone. Employers can select which Medicare Supplement (there are 10 or so plans, A – J) to provide as an employee benefit. The payment of the premium of this supplement is taxable to the employee. High deductible supplements would permit the participant to have a Health Savings Account. Everything is portable when one terminates employment….. the individual can either stick with the supplement at time of termination (and pay the premium to the carrier), or go with the A – J plan offered by the next employer. In 10 years anyway we’ll have LOTS of people looking to the government for Medicare and veterans looking at the VA. In the meantime, we’ve GOT to do something to increase the number of health care providers. I’ll be motivated to stay healthy to avoid LONG waits for appointments and spending hours in a waiting room. It’s already bad.

By: Juanita6

Juanita6 — Fri, 14 Aug 2009 22:08:26 +0000

Years ago I saw a tee shirt on someone at a golf tournament. It said, “If you’ve got ‘em, floss ‘em.” I thought about all the money my parents put into braces to give me something to “floss.” I’ve done so ever since. Lesson: tee shirt messages can work!!

By: Peggy

Peggy — Fri, 14 Aug 2009 21:29:59 +0000

Um, has anyone thought of one of the other “personal responsibility” topics, one of the definite 3rd rails? People who have 8 or 10 or 12 (or in the case of one of my neighbors, 21) children?

By: Audrey (aka Auð)

Audrey (aka Auð) — Thu, 13 Aug 2009 06:13:09 +0000

I really do not care for the “state” to tell me what is healthy and what is not. It can easily turn into what I should and should not do. Obama – Communism you can vote for.
It is just assumed that “obesity” is personal responsibility. That obese people, if they had the willpower, should be able to control their bodies.
Whether we like it or not, it simply isn’t true. There are so many overlapping mechanisms that humans have to keep us from losing weight, that it is impossible that there is one “solution”.
Obesity is not a health problem. Other than orthopedic problems, being “overweight” has no correlation to any health problems. The truth is, obesity is a “cultural” problem. It is a problem of style – what is stylish now is to be thin, whatever the cost.
Unfortunately, many people believe that thin is healthy – many studies have shown that being underweight is much more dangerous than being overly fat (and by overly fat, I mean people above 40 BMI)
The truth is, people who have BMI’s 30-35 have the lowest mortality rate.

And if obesity is such a death risk, why haven’t mortality rates skyrocketed? After all, it is commonly said that 60% of Americans are overweight or obese. Then why are we all living longer than ever before?
Audrey (aka Auð)´s last blog ..Tyr Painting…A look back

By: Chris

Chris — Wed, 12 Aug 2009 17:51:55 +0000

JEC-My dentist in the US used to say, “Don’t floss all your teeth – just the ones you want to keep”. That made such an impression on me as a kid that I am a devout flosser.
Chris´s last blog ..New Hairdresser! Yikes!

By: mitch

mitch — Wed, 12 Aug 2009 10:49:24 +0000

This site has the most interesting discussion on healthcare costs that I’ve yet read, because this issue of personal responsibility vs. personal freedom is truly the heart of the whole problem we are facing as a country. It goes far deeper than just our body shape –bodies are just a physical manifestation of our mental/spiritual condition, which is one of passivity and lack of self-discipline. Truly, there one can find the connections between our out of control health issues (obesity, smoking, etc.) and our out of control spending issues (credit card debt, mortgage foreclosurers,the government’s budget in general, etc.) I believe we must address this issue head-on, and then the rest will follow. As a nation, we have allowed ourselves to be manipulated by others (advertisers, government officials, etc.) into believing that we are incapable of doing anything for ourselves. We need to instill the quality of self-sufficiency back into our national character. All the problems being discussed at this site trace back to a lacking in this area, such as the comment earlier about an overweight diabetic woman who was content to just pop a pill (an external control) rather than control her problem herself by eating properly (an internal control). In the end, control must happen. If we don’t do it ourselves, it will be imposed on us from the outside in the form of oppressive government regulation. This can only happen if, once again, we choose to not be self-sufficient and instead ask the government to take care of us. If you want someone to pay your bills, then you have to face the fact that they have a right to restrict the way in which you acquire those bills. The fact that so many people are willing to lose their personal freedom in order to be taken care of by the government is indicative of how far we have traveled away from the quality of self-sufficiency, a quality that was once the defining quality of what it meant to be an American.

By: Emily

Emily — Wed, 12 Aug 2009 07:34:53 +0000

Personal responsibility? How about “personal” responsibility for the insurance industry, the pharmaceutical industry, and the fast food industry — all of whom are deeply invested in perpetuating behaviors that are harmful to our health. Obese? The insurance company will pay for expensive gastric bypass surgery, but will not pay for 6-months of education with a certified dietician. Diabetes? The insurance company will pay for amputation of an infected limb (and a lifetime of disability and further medical complications), but will not cover (again) the services of a dietician/nutritionist. Hypertension? Big pharma pushes the pill-popping quick fix, and discourages changes in lifestyle. And the fast food industry continues to push their “drugs” on our children — with cheap and easy access to the foods that will make us the sickest. (They have even discovered ways to make a salad a high calorie, high cholesterol, high fat meal.)

This whole discussion of “personal responsibility” is a joke until we take into account the powerful industries (and lobbies) that deliberately mask their activities in order to turn a profit. There’s a reason that “unhealthy” stuff is cheap, easy, and readily accessible — because someone, somewhere, is making BIG money off of it.

Give people the opportunity to make reasonable and equitable choices and THEN talk about personal responsibility.

By: Whatdyaknow

Whatdyaknow — Tue, 11 Aug 2009 23:13:33 +0000

Hmmm, socialized medicine is not a new concept…It seems to be working in other countries….I don’t hear them complaining about it. IN FACT, the people I know in other parts of the world are GLAD that they’re NOT Americans. They cannot believe we live this way. My friends and I have from time to time discussed what we would do if we found ourselves with an illness that could potentially bankrupt our families like cancer. We all agree the most sensible thing to do would be to go over the border to Canada where treatment is free. Americans are true to the notion of putting money ahead of people. I think I’m in the minority when I say people should come before money and that everyone should be entitled to the same level healthcare as everyone else. It’s so sad that some think of themselves as more deserving than the next. Let me add to that that I feel we should not have to pay for education (college/ trade schools). Education should be accessible to all EQUALLY.

By: Matt C

Matt C — Tue, 11 Aug 2009 21:26:50 +0000

I don’t think you’re really suggesting limiting a company’s right to advertise, but I get what you’re saying. Drugs are hard to produce, and in order to make them profitable they have to advertise. I believe the root problem is a system with low personal liability for trying so many drugs. If you can go to your doctor and get a prescription for Latisse (eye lash thickener) and only pay a $15 co-pay and also pay the same co-pay for your heart pressure medication, therein lies the problem. The expense of the eye lash thickener is being passed on to the general group just as the heart pressure medication. I believe most of us don’t mind sharing the burden for heart disease, but I don’t think very many of us want to share in the cost of some beauty queens eye lash growing problem or subsidize some guys four hour erection.

By: Matt C

Matt C — Tue, 11 Aug 2009 21:15:22 +0000

Sadly that is the nature of insurance. You pay more for car insurance if you have a lower credit score – this happens because statistically people with lower credit scores get in more accidents. Same thing with young males 18-25. I paid more for my insurance because I was in that category – even though I never got in an accident or even a speeding ticket. I believe we do need to address this issue. Someone with cancer or who has undergone fertility treatments (try getting private health insurance after using Clomid) should still have access to affordable health insurance. I believe, however, that lifestyle choices that lead to health problems e.g. obesity and smoking, should pay more.

By: CJ Vah

CJ Vah — Tue, 11 Aug 2009 20:47:21 +0000

Let’s all just face the predominant facts folks.
We Americans for the most part are overweight.
And it’s all because we eat more calories than we burn.
We’re lazy. We watch too much TV. We eat too much garbage food.
And we blame everything and everyone else.
For those reading this that are overweight(and you know who you are) ask yourself these questions.
Are you really, truly doing anything to lose that weight?
Did you join a gym on January 2nd, go for a few weeks then quit?
Should I, a healthy 45 man, who eats well, exercises regularly, does not smoke, drinks moderately and on weekends only, pay for your health costs if your uninsured?
If you say yes then I will pay my government mandated amount.
But then will you be willing to fess up and pay for 2 months of my gym membership?
If you land in the hospital with heart disease due to your weight and I have to help foot the bill, can I send you my bill for a new pair of biking shorts, new tires, a couple new shirts and a water bottle?
On the other hand maybe we should let this whole health care happen and give Obama what he wants and then mandate those naive folks who put him in office in the first place to pay for the whole thing.
Those same folks who statistically don’t have insurance to begin with – the 19 – 25 year olds – you know – those vibrant, healthy, non smoking, texting, twittering, know it all’s out there that think Operation Desert Storm is a Wii game.
They’ll learn a valuable lesson in politics; they’ll be forced to get insurance and pay for something they won’t benefit from (like us babyboomers and Social Security).
Yea, I like that idea! Anyone else?

By: marilyn

marilyn — Tue, 11 Aug 2009 20:02:27 +0000

When I was in labor, 2 nurses said to me “I hate you, you are so thin”. I felt like a beached whale so you can imagine my shock but they were more than 300 lbs each. Later I asked them to clear the air from the iv line but instead they showed me how much air could be injected without killing me. I was terrified! Obviously they really hated me because I was a healthy size only carrying the extra weight of the baby. This weight problem impacts health care many ways. It worries me that many health professionals are so terribly overweight that their self image and professionalism is gone. Any advice they give about health falls flat because obviously they do not follow their own advice. Thin people should not be hated by fat ones. I complimented those nurses on everything I could think of just to try to win their favor and save my life. I would gladly have taught them how to increase their activity and eat sensibly if they had given me half a chance.

By: Anne

Anne — Tue, 11 Aug 2009 17:25:45 +0000

AMEN TO THAT SUGGESTION!! Used to be your doctor would suggest medicine to you, know we see on the TV “if you think this is right for you, talk to your doctor”. If the pharmacuetical companies budget for marketing was slashed due to limited advertising, perhaps it wouldn’t cost so much for the actual pills!!! Let’s leave it up to the doctors to decide what works best for us and that way we don’t have people lining up for medication that has such bad side affects!

By: Anne

Anne — Tue, 11 Aug 2009 17:14:13 +0000

I find it amusing that people are talking about personal responsibility here about healthy lifestyles, and yet, no one correlates that to the entire discuss of health care reform. I have been uninsured. I have bought individual coverage. I have been covered under a group policy. At every stage of those times I knew what I had to do to cover myself, to protect myself. Honestly, the package they are putting together scares me. I know people that are from countries with socialized medicine. What people are asking for and what is going to be done is not going to equal any kind of positive outcome. Read the fine print. Why else do you think the program isn’t set to truly role out until AFTER the next election? We need change, but not like this. Yes, people need to be more responsible, but thin people who eat right get diabetes too! Genetics play a substancial role in the disease. If you want to play that card, then look at the food that we have available–all the estrogren, preservatives and pesticides/garbage that is put in to food that is “good” for us! Am I the only one that see’s how many people are getting cancer in relation to what it was 30-40 years ago? What changed? The ingredients. I would LOVE to have food that is bad for us at a higher tax rate than those that are good for us! Then maybe it wouldn’t be so expensive to buy vegetables and fruits–but lets get all the pesticides and preservatives off them! Inactivity isn’t the only reason kids are overweight! I agree we need to be more active and eat right–but that isn’t the only thing that makes people sick!

By: JEC

JEC — Tue, 11 Aug 2009 15:54:59 +0000

On personal responsibility: I’ve practiced General Dentistry for
30 years and educate everyone of my patients about proper oral health care. About 90% of what we do in dentistry is PREVENTABLE. Do patients listen???? Yes. Are they compliant—maybe 15%. Behavior is a difficult thing to change—we counsel teens on the amount of sugar in sports drinks (we tell them to divide the number of grams of sugar by 4 to get the no. of teaspoons of sugar in a drink eg. A 12 oz can of Coke has 12 gms of sugar—i.e. 3 teaspoons of sugar). Do they change their habits—-maybe 15% do. With this as a micro model for the medical problems I’m not very confident that people will change behavior. Schools compound the problem by having unhealthy products for the kids—BUT then schools are PAID by the venders to have these unhealthy foods.

Perhaps the best model in the blogs above is to reward good habits (i.e. proper weight etc) with lower premiums—–BUT then the greatest percentage of health care costs are used by a small percentage of patients—-who make poor choices to begin with; in turn they are usually poor and cannot afford insurance anyway. Sounds like we’re going in circles doesn’t it??

Alot of good suggestions in the above blogs. Obama is trying to solve a VERY COMPLEX problem with a magic bullet. Simple approaches sometimes work best with complex issues.

Probably the best model for change is to reward behavior through reduced premiums—but then if the care is free why should they change? This is the problem with all welfare and medicaid programs.

The people who have submitted blogs here show more intelligence than 90% of our representatives (exceptions are Tom Coburn,M.D. Oklahoma, Orrin Hatch of Utah). A Congressman on CSPAN the other day didn’t even KNOW there was a problem with insurance companies going across state lines (each compnay is licensed to do business in each state). Such ignorance is frightening when they don’t know the core issues in the health care debate. And they want to reform the WHOLE SYSTEM????? Lord help us if they try to cram this thing through in a rush to “do something”.

By: ChrisC

ChrisC — Tue, 11 Aug 2009 14:33:54 +0000

Sad to hear, but I understand what you mean about the costs. The problem as I see it is that there is currently no “cost” to this way of thinking. Want to live forever? Fine – pay what it costs to do so. There are the upfront costs of living a healthy lifestyle; or there are the back-end costs of popping miracle pills or extreme surgical choices. I have 3 friends who have had the gastric bypass surgery – all of them primarily due to unhealthy lifestyles (which sadly continued after the surgery, leading to further complications, I might add). Healthcare certainly costs money, but those who are reckless users of the system should not be shielded from the bulk of this cost. This is where the effects of personal choice should be clear.

By: ChrisC

ChrisC — Tue, 11 Aug 2009 14:23:40 +0000

I completely agree. Rewarding people for “good” behavior through their pocketbook is the only way to truly get the public’s attention. Similarly, lifestyle choices could impact the cost of your insurance when you first start with a plan.

I do have a problem, however, with increasing a worker’s insurance premiums based on preexisting conditions. Some people have medical issues they will need the insurance for; simply increasing their premiums the more they use is simply takes us to a more extreme version of fee-for-service than we currently see. Over time, a certain amount of this is to be expected; but base-level insurance for all workers, regardless of their existing medical conditions, should be the goal.

Anyone have a thought on this dilemma?

By: ChrisC

ChrisC — Tue, 11 Aug 2009 14:13:32 +0000

I certainly understand the complexity of this issue. What we are essentially discussing is the degree and manner of encouraging “virtuous behavior”, however defined. While there is likely no one good solution to grab hold of, there are employers who recognize the value of rewarding behaviors that will likely encourage better health among their employees. I’m thinking of employee incentive programs that reward people – with money or other useful incentives – for swimming laps; walking miles; getting regular checkups; adopting nutritional programs; changing unhealthy behaviors. These programs are voluntary, but clearly provide a tangible benefit to the person who participates. The problem with these sorts of employee incentive programs seems to be (for the most part) that they may not seen as practical or affordable by most employers. But if we could find a way to make them more practical or affordable, and to systematically incentivize behaviors that would likely reduce an individual’s use of the health care system, we could bring down some of the costs of providing care – regardless of the actual individual impacts. Personally, having watched two parents die of two very distinct (and painful) smoking-related illnesses, I’m convinced enough of the benefits of a healthier lifestyle and try to follow one. But I recognize that change is hard for some, and lifestyle is not the only factor in use of the healthcare system. Still, I believe I understand well enough that substantial benefits can come to anyone who cares to live a healthy life – just as I know that my insurance premiums help to pay the costs of care for everyone who couldn’t care less about doing so. Surely this is an idea worth pursuing.

By: Chris

Chris — Tue, 11 Aug 2009 13:44:12 +0000

Let’s throw annual check-ups into the bag of personal responsibility. I’m American but I’m currently living in Poland where we have public health care and a parallel private system. It is quite common here for older women to just simply not visit the gynecologist. My mother-in-law hasn’t been to gyn. since her last child was born 35 years ago and there’s no regulation forcing her to go. A once a year visit here is paid under the state’s health plan. After the passing of several relatively young female friends and family members, she still could not be persuaded to go to the dr. Certainly, it would be to the a state’s advantage to force people to have check-ups than to pay for their cancer treatment. Also how would dental and eye care be treated under the proposed reform?
Chris´s last blog ..New Hairdresser! Yikes!