Preface: This should be considered a polemic meant to stimulate debate, not some deeply held view of mine. It was followed up with several other posts that mitigate this one—
here and
here.
I was listening to one in an endless string of liberal talkradio hosts railing on about the right of all americans to have access to healthcare. The main argument seems to be that people have the right not to die prematurely and they should not be penalized because they are stuck in a job that has poor benefits and a country that will not step up to the plate. But as usual, an important issue is ignored. With rights come responsibilities. The concept that the primary reason people die prematurely in this country is due to lack of health insurance is just patently false. The primary reason people die prematurely is because of how they take care of themselves. The vast majority of deaths in the US are due to preventable diseases related to poor lifestyle. Most of the cost of healthcare comes late in life and is due to the factors of being overweight, eating bad foods, not exercising and being a smoker or alcoholic. The diseases caused by these factors account for perhaps half the cost of healthcare in the US. They are type 2 diabetes, atherosclerotic coronary artery disease, liver disease and lung and colon cancer. A much smaller number of diseases that lead to great suffering and death are due to unknown causes, perhaps genetic or infectious. I certainly believe that victims of infectious or genetic diseases should not be deprived of healthcare. In the case of infection, it is just in the greater public interest to treat such conditions so they do not spread to others.
But a question must be asked. Why is it anyone's responsibility to pay for the treatment of the chronic diseases of an obese alcoholic smoker. I do not see why either the government, employers or insurers should be required to cover the expense for those who make no effort to take care of themselves. In fact, if Americans cleaned up their act, the current healthcare expenditure in the US could easily pay for the necessary care for all Americans since so much would be saved by not having to treat the millions of preventable terminal diseases each year. We often hear that Europeans have better health, spend less money on healthcare, deliver it more efficiently and that no one goes uninsured. I think the evidence that this is true is overwhelming and conservatives who argue otherwise have never provided even a shred of evidence for their opposition based solely upon economics. But what is ignored in that analysis is that the Europeans in question, such as the French, also lead far better lifestyles. Up until recently, the rate of obesity amongst French women was 5%, compared to 35% in the US. Recently it has jumped to 11% in France. I'd lay a wager that if obesity reaches American levels in France (or Japan), the public will not be so willing to shell out the cash to cover the expenses incurred by those who bring much of their suffering upon themselves.
I would be more than willing to support a universal national healthcare system, but if and only if the right to healthcare was tied to taking responsibilities for one's own health. Just like the welfare to work programs eliminated the right to being on the government dole, yet left a safety net in place, we could create a similar system for healthcare. Enroll all Americans in a healthcare plan for free. They have 2 years to lose weight and demonstrate they do not eat the wrong foods, smoke or drink excessively. They will be checked once a year after this to insure compliance. The main focus of the program will be to support these goals. Those who opt to ignore their responsibilities are then on their own. One talkshow host this morning was saying he did not believe everyone in America had the right to the same outcome in the marketplace, just the same opportunities. He said he believed in a safety net below an essentially market based system. He said it was imperative for all the advancement and progress we had seen over the centuries for there to be some incentive to achieve, but that anyone who worked hard and played by the rules deserved to have certain basic needs met. I couldn't agree more. Well, here's the the rule for healthcare. Take care of yourself and you get it. Abuse yourself and you don't.
If you are one of the lucky who is rich enough to pay gobs of money to provide the healthcare you will need after abusing yourself, I guess that is just one more perk of success. But if you are not so lucky, you can still get what you need. You just have to make a little effort. Is this fair that those who are rich can abuse their bodies and still get healthcare? Well, is it fair that those who are rich have private planes and yachts and mansions and all else that money can buy? If you support the idea that capitalist incentive has some value in society, then this is one of the outcomes. But it is just plain false to claim that the only only solution for the healthcare crisis is just to insure every obese person in the country as if there was no difference between them and those who took care of themselves (and research proves all but 2% of obese persons are obese solely due to overeating and lack of exercise). In fact, giving that right without requiring the commensurate responsibility will only lead to massively escalating healthcare costs that will eventually destroy our economy and deprive even those who work hard and play by the rules of their rightful opportunities to succeed. Does this sound heartless and insensitive to those who may suffer as a result? Why not turn the question around? Do those who abuse themselves and then expect their employers or other taxpayers to foot the bill care about the repercussions they cause for the rest of us struggling to get by on our meager budgets. The sword swings both ways and the power to be healthy is in the hands of most people if they just got up from their couches, walked a mile to the store and bought some vegetables for dinner.
