Advocating personal responsibility in health: Bullshit!
We have observed a lot of discussions lately about health insurance and the role of personal responsibility. None was more prominent than Whole Foods CEO John Mackey, who indicated in his recent WSJ article that many of the health-care problems in the U.S. are self-inflicted and about 70% of all health-care spending is preventable. Basically, Mr. Mackey implied that by changing our eating habits (via buying items at Whole Foods, I assume) and having a more active lifestyle, we don't need to significantly reform our health care system (other than the tax related stuff, such as the useless Health Savings Accounts or HSA). Like so many people on the right, John Mackey is advocating that personal responsibility is a critical component of health care reform.
Before I go into the heart of the matter, I need to point out that I am not disputing that eating healthier food and being more physically active will be very beneficial, as discussed here and here. However, is this enough to solve existing health care problems? So much so that we should keep the status quo about how health care is delivered in the United States?
Well, let's find out, shall we?
As usual, I dug out very interesting facts I would like to share with all of you.
According to the University of Kansas Medical Center, there are approximately 13 million people in the U.S. who suffer from a genetic disease (there are 15,500 recognized genetic disorders!). Here is a sample of what researchers at this Center reported (based on peer-reviewed publications):
- 11.1% of pediatric hospital admissions are for children with genetic disorders.
- 18.5% of pediatric hospitalizations are for children with congenital malformations.
- 50% of individuals found to have mental retardation have a genetic basis for their disability.
- 12% of adult hospital admissions are for genetic causes.
- 15% of all cancers have an inherited susceptibility.
- 10% of the chronic diseases (heart, diabetes, arthritis) which occur in the adult populations have a significant genetic component.
It is interesting to note that many cancers and chronic diseases are in fact caused by a genetic propensity. Burgers may not be that bad for your health after all… just kiddin'!
The Center also notes that the lifetime costs associated with some of these genetic diseases could be as high as $1,000,000. Yep, $1M! I am wondering how many servings of fruits and vegetables this amount is equivalent to. On a more serious note, how many Americans could afford these lifetime expenses, even with full (private) insurance coverage?
According to the Centers for Disease Control and Prevention (CDC), non-intentional injuries are considered a serious public health problem. In fact, it takes a toll on the health of the population and imposes important social and economic costs on society.
The CDC conducted several studies on this topic. I therefore decided to show some of these relevant statistics. Please note that they probably include many people who are vegetarians, vegans or eat healthy as well as have an active lifestyle.
Below, you will find the total number of people who were injured in 2004 in the U.S.:
- Deaths (Fatal Injury): 162,000
- Hospital Discharge: 1,903,000
- Emergency Visits: 29,529,000
- Doctor Visits: 31,128,000
- Outpatients Visits: 3,852,000
These statistics show that, in 2004, approximately 66 million people (or about 20% all Americans) were injured in the continental U.S. (note: some of these values may include people who may have been injured more than once). These injuries varied from minor cuts and bruises to those causing the death of a person (which also has societal and other directly related costs). The year 2004 seemed like a fluke? Well, check out this 600-page report published last year by the CDC.
If we add the people who have a genetic disease (aka pre-existing conditions for the insurance industry) to those injured, we have about 80 million Americans who may not have benefited greatly from eating healthy or being a personally responsible human being. I include myself as part of this group.
I can see some of you arguing that non-intentional injuries are actually preventable. In theory yes, but closely examine the report above and you will notice how the number of injuries remains constant over the years, despite numerous efforts made to reduce these numbers (see this recent ad campaign, which apparently won't be shown in the U.S., as an example).
Now, let's put this in perspective!
Given my line of work, I will focus on motor vehicle collisions. Every year, there are about 28 million motor vehicles that are involved in a crash. Since there are approximately 250 million registered vehicles in the US, this means that a little bit more than 10% of all registered vehicles are involved in a collision on an annual basis.
Now, if we require that every driver carries motor vehicle insurance* when only 10% of these vehicles are expected to be involved in a catastrophic event (insurance terminology), why don't we provide health insurance for everybody when the risk of being injured, suffering from a genetic disease or becoming sick (e.g., H1N1, STDs, bacterial infections, etc.) is much higher?
As I discussed in a previous post, providing health insurance under a single-payer system is the best way to spread the risk and minimize health care costs.
To conclude, if Mr. Mackey and others are right about the significance impact of personal responsibility, why do all other industrialized countries still provide health care coverage for all? In these countries, the government also tries to improve personal responsibility via policy measures and media campaigns. Nonetheless, all these governments still believe in social justice (without being real socialist countries).
*This measure is used to reduce societal and user costs. (Update, Sep. 4th, 2009: I discussed this point in greater details about why this comparison is valid in response to a comment below.)
Thanks to Rat4Cat for his input.