By Kim Bellard, August 20, 2012
I’ve been thinking about something a very smart friend of mine wrote me in response to one of my previous posts: “…I can see where technology and information-driven consumerism might work for some highly motivated and educated people ... but not the masses I see at Walmart.” I’m sure he meant no disrespect to either Walmart or its shoppers, nor do I, but one can go to pretty much any shopping venue and understand his point.
The grim statistics are well known -- e.g., we’re too fat, we rely too heavily on medications, incidence of lifestyle conditions like diabetes is soaring, and, of course, we spend way more on health care than any other country. Despite all that, though, Americans remain pretty cocky about their health, with the vast majority claiming to be in “good” or “very good” health, higher than in other industrialized countries.
We claim to exercise, with over half claiming to exercise at least 1-3 times per week, but we may be kidding ourselves, as only about 5% report exercising on any given day. Similarly, Americans are in denial about their burgeoning weight, reporting they have actually lost weight when, in fact, they gained. The bottom line is that most of us are not really in shape, and it is impacting our health.
One of the most telling responses to this problem appeared recently: Dr. Michael Joyner of the Mayo Clinic suggested that our lack of exercise should be considered a medical condition. I understand his point, since we’re obviously not doing a great job of staying healthy on our own. Certainly getting more regular exercise would help many people – and, most likely, they know it – but medicalizing lack of exercise seems to me as more of what got us into this mess.
It’s not that various parties aren’t trying to encourage us to live healthier lifestyles. In a recent post, Clive Riddle reported on the recent Aon Hewitt 2012 Health Survey of employers, citing in particular the widespread use of financial incentives towards lifestyle changes. That’s encouraging, and a recent survey by the National Business Group on Health echoed employers’ adoption of wellness efforts, but also reported that over twice as many employers – 43% compared to 19% -- see increase use of consumer-directed health plans (CDHPs) as their most effective strategy for controlling costs. In other words, employers are happy to try dangling the carrot, but they still plan to use the stick.
Employers aren’t the only ones trying to lead us to improve our health; the government is trying as well. For example, a recent study found that state laws restricting the sale of snacks and sugary drinks in schools did result in children gaining less weight. That’s notable for at least two reasons: first, that there are a number of states already legislating such choices, and, second, that such efforts may actually work. No wonder Mayor Bloomberg wants to ban large sizes of sugary drinks in New York City.
In a country where, apparently, the government can require you to buy broccoli (as long as they call it a tax, not a penalty!), the prospect of it telling us how to live is a little scary. Then, again, this is a government that can’t even ensure that its retirement payments, whether Social Security or federal employee pensions – meet their one main test, i.e., that the recipient is actually still alive. So maybe I shouldn’t start worrying about them monitoring my ice cream consumption just yet.
How did it come to this, that we’ve delegated the responsibility of keeping ourselves healthy to third parties, including physicians, employers, or the government? Some of the problem may come from the fact that parties in the health care system are, in fact, treating us like consumers. Not in the respect of competing on price or quality, mind you, but in using advertising to drive consumer decisions based on image. The saga of the impact of direct-to-consumer advertising for pharmaceuticals is widely known, with such advertising spending exploding to close to $5 billion annually after such ads were allowed in 1997. Some are calling for an end to DTC pharmaceutical ads, as the CBO studied last year. The hospitals are also getting into the act, pouring money into advertising, as the New York Times reported last year. Throw in spending by various diet and alternative medicine alternatives, and it becomes clear that we face a lot of forces telling us that some other person and/or product is the key to our health. When we don’t directly pay for some large portion of those, as health insurance can allow us to believe, the temptation to not shop prudently is almost irresistible. We may shop for flat screen TVs at Walmart, but when it comes to health care, we think we deserve to be Neiman Marcus shoppers.
There are certainly many situations were medical advice and treatment is not only appropriate but also necessary, and thank goodness that our clinicians are always finding more ways to combat our various maladies. We have more and better options all the time, even though often those options are more expensive and sometimes not as clearly beneficial as we should expect. But the responsibility for our health does not lie in those clinicians’ hands, much less in the hands of our employers or government officials. I don’t have any reason to expect that Americans will be better at managing their health than they are at managing other aspects of their lives, but we shouldn’t be worse either.
There is a lot efforts around “patient centered medical homes,” which include many good ideas, especially better coordination among health care providers. As long as the focus is “medical,” though, the “patient centered” part of it is going to lack important components necessary for improved health. Health is the result of a complicated interaction of genetics, environment, lifestyle, social influences, and medical interventions, to name a few. We need to break out of the medical model to truly get at health.
We talk about the health care system, but in truth it is still the medical care system. If we’re serious about improving health, and impacting the quality and cost of medical care, maybe we need to step back and think about a health care system really should look like.
I’m sure that some Walmart shoppers are spending beyond their means, buying things they don’t need and can’t afford. Some are perhaps even in bankruptcy. But I like to think that most of them live within their means, and have learned how to manage their financial health. We should be thinking about what in our current system leads us to not expect them to do the same with their actual health.