If physicians treated symptoms, they would never cure. Prescribing a cough suppressant to a patient with an intractable cough without searching for an underlying cause, for example, is obviously foolhardy. If cancer were present, it would inevitably progress and take that patient’s life. Cure comes through recognizing symptoms and parsing them to diagnose and treat disease. Problem-solving in health policy should employ the same approach.
The ideological banter surrounding health care reform has mistakenly focused on symptoms, however, missing the disease that inhibits the system’s ability to provide readily accessible, high-quality, cost-effective health care. Unsustainable costs and access problems do exist, but these are merely symptoms of the underlying disease.
Other symptoms are readily apparent. According to Gallup, 62.6 percent of Americans were overweight or obese in 2010. Obesity is associated with high blood pressure, elevated cholesterol, diabetes, heart disease, degenerative joint disease and various cancers. As a result, the annual medical costs for an obese person are $1,429 more than a person of normal weight, adding about $147 billion in costs to the health care system in 2008.
The societal and personal costs of unhealthy lifestyle choices extend beyond obesity. According to the Centers for Disease Control and Prevention (CDC), 90 percent of lung cancer deaths in men and 80 percent in women result from cigarette smoking, and a total of 446,000 people die annually from smoking-related diseases. Yet about 21 percent of adults continue to smoke, adding $96 billion annually in direct medical costs to society.
The overall prevalence of illness in our society is avoidable. The CDC notes that four modifiable health risk behaviors — lack of physical activity, poor nutrition, tobacco use and excessive alcohol consumption — are responsible for much of the suffering and early deaths related to chronic diseases. Physicians’ waiting rooms and hospital beds are filled with patients there not because of a genetic predisposition to disease or a random stroke of bad luck, but because of poor lifestyle choices.
If avoidable illness, unsustainable costs and inadequate access are symptoms, then what is the disease?
The disease lies in the construct of the current health care system: We snub our noses at the laws of basic economics and ignore the subtleties of human motivation.
Under the current system, most people do not directly pay for health insurance. They obtain it through an employer or the government. This is not to say that individuals do not pay for their insurance. An employer develops a compensation package commensurate with a worker’s production, and that package is a combination of salary and benefits. In the employer-sponsored model, the average worker loses $2.40 in hourly wages to cover health insurance. This is money that the worker no longer personally manages. It removes a cost-control barrier: No one spends others’ money as wisely as they spend their own.
The current system’s comprehensive approach to health insurance further separates patients from control of their health care dollars. The model is arranged to minimize the cost of using the system, which shields people from the financial impact of unhealthy lifestyle choices and promotes moral hazard. Insulating people from the outcomes of risky behavior allows them to pursue that risky behavior. It becomes easier, and often cheaper, to avoid lifestyle modification by taking a pill for elevated cholesterol instead of joining a gym or changing eating habits.
While the individual’s personal costs are minimal, the explosion of cost for the health care system comes from the new medication, additional office visits, monitoring tests and likely future development of associated illnesses such as heart disease and hypertension.
The cure won’t come until the illness is addressed. The new federal law, the Patient Protection and Affordable Care Act, does little more than attempt to treat the symptoms of access and cost through greater central control. It expands the current dysfunctional model and exacerbates the moral hazard: It further separates the person from control of health care dollars and removes ownership of health care decision-making from the individual.
The attempt to cure requires models that empower patients as active participants in their health care to promote personal responsibility. Models that adhere to the principles of every other functioning market: the premise that individuals can better control their health care dollars and purchasing
The data from the enactment of consumer-driven health plans demonstrate the potential to truly begin to treat the disease. This regimen focuses on curing the disease behind the unsustainable cost, inadequate access and general level of unhealth. This cure moves society toward that end so desperately needed: a readily-accessible, high-quality, cost-effective health care system.
Dr. Brian E. Hill, a Georgia urologist and author of “Stop the Noise: A Physician’s Quest to Silence the Politics of Health Care Reform,” wrote this commentary for the Georgia Public Policy Foundation.
