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SEPTEMBER 2, 2009 10:41AM

Advocating personal responsibility in health: Bullshit!

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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.

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Brilliant, this should be read far and wide.
Steve: Thank you! Yes, it would be nice. Don't hesitate to pass the word around.
Excellent. You destroyed Mr Mackey's position with reality.
This is quite simply an excellent piece!

I'm reminded of the Rush Limbaugh Healthcare Plan:

Elderly caller: I broke my wrist, and it cost me $6,000! I don't have $6,000...

Rush Limbaugh: Don't break your wrist!
SuznMaree and Norwonk: Thanks! Greatly appreciated.
Best response yet to these infuriating editorials. If these wildly affluent people really believed in taking personal responsibility for health care they would pay their damn income tax and shut up. Mackey and Ornish have made millions off the basic human desire for decent nutrition. Their arguments are self-serving and disingenuous. Is "Big Government" going to actively prevent people from healthy living? Is it going to be harder to monitor than a hundred different insurance companies?
Juliet: You made very good points! I really like the following quote: "If these wildly affluent people really believed in taking personal responsibility for health care they would pay their damn income tax and shut up." Well said!
The taking-responsibility-for-your-health crowd often seem to be in denial that human beings eventually get sick and die, no matter how many marathons they run, how many fruits and vegetables they eat. Death is not preventable.

Thanks for the excellent post.
I sent some stats like this around and was told to "stop my liberal bullshit", which I found a fascinating response, since quantifiable data is by definition the opposite of bullshit.

I have always longed to ask those who take the perfectly good idea of personal responsibility to such an absurd extreme what they think we should do about all the elderly people who have outlived their friends and families but need serious medical care, for example. Or the handicapped. Or the disabled. Or the orphaned. Or the mentally ill. Seriously, what are those who are literally unable to exercise personal responsibility supposed to do - die quietly? Hey, maybe those in warmer climes can substitute festive plastic floaties for ice floes.
Great post.

I just can't understand why the U.S. doesn't do what virtually all the other industrialized nations have done.  

Wow, am I happy or am I happy that I'm descended from United Empire Loyalists...
Redstocking: Very true, it is not a matter of if, but when! Everyone will eventually become sick and pass away (as sad as it is).

Lorelei: Very good points. I often use published papers to support my arguments. I was recently able to silence a few people on other websites. In one case, I referred to more than twenty papers/research work on a single topic. Interestingly, this person asked “lefties” to support their arguments before I showed up on the thread. However, I put so much stuff to illustrate how wrong she was that she erased the entire thread. This is what we call being intellectually honest.

LuluandPhoebe: You are absolutely right. People there are probably healthier than us, but they are still all covered in one form or another.

incandescent: Thanks a lot! Thanks also for passing this article to others. I hope many people will read it.

Myriad: Many thanks as usual! I know you do not have to worry about this stuff up north.
TheBarkingLot4: I am sorry about to hear about your situation. I hope you won’t lose your insurance. The savings you noted are very impressive. I am not surprised actually. Under a universal health care system, you deal with one insurance entity, the government. Here, each clinic, hospital or laboratory has to deal with numerous insurances companies, with each company having its own sets of rules and procedures. I discussed this topic a few months ago here. Thanks for dropping by.
One of the flaws in your logic is the car insurance. You have car insurance not to protect you but to protect me. That is why you are required to carry it. You don't have to have car insurance on your car unless it is financed then the finance company is going to want their interest protected, just like those on the street you are hitting.

Health insurance is to protect you. Just like the part of your car insurance that protects you, you have the right to protect yourself or not.

So why should the government force you to buy something you don't want? Millions of younger people don't have health insurance because they don't want it. Should they be forced to buy insurance? They don't make you buy a newspaper you don't want to read do they? Why not?
Nobody should be forced, but by not having insurance those young people do no good both to themselves and the society. Consider the following. If those young and uninsured get a contagious decease in an early stage, they are unlikely to go to the doctor soon, they will probably get to the doctor or an emergency room when it has gotten worse. In this scenario they will be endangering many other people. Another scenario - an accident. They risk personal bankruptcy and someone will still have to pay for it. Also, by foregoing the preventive care for non contagious deceases, they up the costs of their future care. In the conclusion, I'd like to say that usually this kind of people do not buy insurance because it is expensive if purchased individually. This is really the major reason why they do it, not for the sake of freedom. If there was a cheap option available, it makes all the sense in the world to have it in order to spread the risks, lower the total costs and not endanger anyone. The idea that the young and the healthy really do not need health insurance is bogus. And changing subject to "freedom" of choice between insurance and no insurance is not doing any good to the whole debate and is diverting the attention from the real problem. That insurance is unaffordable for many and barely affordable for even more for the reason that it is currently there for its own sake and not for the sake of the patient.
catnlion: It is true that car insurance is mainly used to protect others (although car insurance in the U.S. includes provisions to cover your own injuries). In fact, you can get insurance that only covers property damages to others. However, you need to look at the bigger picture. Why do we, as a society, require that every driver buys car insurance? The simple answer is to lower the risk for people to go into insolvency (among others) when a catastrophic event happens. Because when this happens, we all pay for it. In other words, it impacts the whole society (see my note “*” at the end of the post). Thus, the comparison is entirely valid.

The same principle applies to health care. When people go into bankruptcy, become disabled or die prematurely due to the lack of health care coverage, it also affects all of us. For instance, since I pay taxes for young people to attend state schools, get an education, and become productive members of the society, I do not want say a few of these people to die prematurely or become non-productive members because they were unable get medical help due lack of health insurance. This will be a waste of my (and your) money.

I can also give you another analogy. I am sure very few people know why the federal government started to invest in road safety back in the 50s. Interested to know? Well, the government noticed that they were losing a lot of fighter pilots, not in air combat or airplane crashes, but in car crashes when they were off duty. Since it is very expensive to train fighter pilots, the government decided that we should, as a society, invest into our highways in order to reduce the risk of losing our fighter pilots (and other members of the society). Obviously, there is still a lot more work to do in order to improve our highway system. Thanks for dropping by. (sorry for any typos, I had to write this very quickly before leaving for work.)
Excellent post, highly rated!

The notion that health insurance is solely to protect oneself is absurd, as is the statement that car insurance is solely to protect others!

Health insurance is predicated on the funding of activities designed to maintain health, thus preventing much spread of infectious disease, and (I suspect even more important for the bean-counters) loss of revenue due to employee absenteeism owing to ill health. It reduces the stresses on the average citizen that can result in mental aberrations up to & including "going postal".

Car insurance, on the other hand, protects the holder from outrageous repair bills & hospital expenses resulting from accidents with injury. It also protects them against damages claimed by others involved in the same accident, which can be truly frightening.

No real difference in intent. Insurance benefits all parties involved. Universal health insurance benefits the entire community.

"The insurance broker who handles our policy told me something amazing: if all hospitals, doctors, clinics, labs, and insurance companies used a universal diagnostic system and universal claim form, it would save billions of dollars. Imagine that -- billions of dollars. How hard can that be to institute?"

They do use a universal claim form, its called a HCFA-1500. There is also the UB92 for surgery and other hospital claims. There are also universal vocabularies for diagnosis and procedures: ICD-9 (soon to be ICD-10) and CPT codes.

The problem is that every insurance company, and individual plans within those insurance companies (think of all the iterations of BCBS -- PPO, HMO, POS, etc.) have different requirements for what they want on that universal claim form, and how they want those diagnosis and procedure codes to be represented. This one is squarely the fault of insurance companies. I'm amazed the broker made that comment, given that s/he works for a company that is responsible for that particular mess.
The problem with "personal responsibility" as it is typically used in the health care debate is that it puts responsibility on the individual but doesn't change the system or situation in which the individual exists.

For example, if Mr. Mackey wants his employees to have more active lifestyles, I would want to know:

1) does he provide shower facilities in his stores so that his employees can work out during lunch, or commute by bike?

2) do his stores have exercise facilities to help his employees stay in shape?

3) does he locate his stores in cities that promote bike transport?

4) does he actively lobby for bike and pedestrian paths?

5) if his employees want to communte to work by bike, does he provide a safe location where they can lock up their bikes?

6) does he actively lobby for zoning laws that create urban areas in which people are not so dependent on automobiles?

7) do his health insurance plans promote wellness? Do his plans encourage people to see the doctor when they need to, or do they discourage people from seeing the doctor through high deductibles and copays?

8) does his company have agreements with local health clubs that will give his employees discounts on club memberships?

My point is that it's not enough to put all responsibility on the individual. If we want to promote personal responsibility we also have to address the systemic and situational factors make it difficult for people to have active lifestyles and stay healthy.
Snowball99 and erikathegreen: We were posting our comments at the same time and, interestingly enough, you raised the same or similar points as I did with regards to the car insurance. Good job to you both!

Stellaa: yes, it is frightening to see how some people think like that, because I am sure some do.

Nora: thanks for providing additional information about the reimbursement process used by the private medical insurance companies.

mishima666: These are very good points about whether or not John Mackey provides these incentives for his employees. I believe a recent post that made front page by a WF employee discussed some of these points. I believe the person’s penname was m.k., but I cannot find the post anymore. Does anyone know if it was removed?

JK: Prevention goes a long way. I noticed that some private insurance companies in the U.S. are more proactive than others. However, when you do not have any insurance coverage, people will not go see a medical doctor when they have to pay the full cost of a consultation just for a checkup. I have witnessed this first hand where I live.

catnlion: you might want to revisit the belief that most young people do not need medical insurance. As shown in the two links below, younger drivers ( 2005 Young Drivers Traffic Safety Facts Sheet

Traffic Safety Facts – Older Population (See Figure 2 on page 2).
Sorry again. It looks like it did not accept that I put the age below 24 in parentheses in the text below. Here is the orginal comment:

catnlion: you might want to revisit the belief that young people do not need medical insurance. As shown in the two links below, younger drivers are the ones most frequently involved in motor vehicle crashes; the crash risk is about two to three times the average, even when we include exposure. Thus, they still need to have proper health and car insurances (for their and everyone else sake).
Not that single payer wouldnt be an improvement - but i believe that a National Health Service option is the best solution.
Let the private carriers and providers do what they will as they will - we can build a system for all without them. A system with paid and unpaid Americans working side by side to provide profit free compassionate care. A system that with enough clout to negotiate prices for goods, and provide free education and tax credits for those who serve - just as we do our firemen and firstaiders.

Some one has decided for us that we cannot or will not take care of ourselves - that we need wankers in far off office towers to decided what care we get or dont get.

What I meant was they don't want health insurance and they don't think they need it. After years of working ER's and flying Med Evac, trust me they do. But at that age you're superman.
catnlion: I agree that young people, especially men, believe they are invincible. Because of this, they tend to take unnecessary risk. This explains in large part the statistics I showed for motor vehicle crashes. Interestingly, my brother-in-law is also an EMT working both as a ground crew and for the Air Ambulance service in Ontario. I believe it is now known under a different name. Very though job.