I have come to a sobering conclusion. All of this talk about reducing healthcare costs through reform is a waste of time unless the American population takes responsibility for their own health. And I don't see much evidence of personal responsibility built into any of the reform plans.
This change will take more than health insurers and employers passing more costs to the individual through higher copays and deductibles—or conversely lowering costs for proper testing, counseling, and immunization. It will also take more than doctors telling patients to get active and eat better or payers reforming payments so that physicians are properly reimbursed for providing that guidance. It will even require more than the government spending millions on wellness and prevention programs that are part of healthcare reform proposals.
All of these ideas are steps in the right direction, but they won't be effective without more Americans taking responsibility for their health.
In an article I wrote for the August 2009 issue of HealthLeaders magazine, I explored the idea that prevention can reduce health costs. During my interviews, one of the most depressing—and truthful—lines about health came from Michael D. Parkinson, MD, MPH, FACPM, principal at P3 Health LLC, which promotes personal and organization prevention, performance, and productivity improvements. Parkinson told me “there is no such thing as a healthy American any more.”
Parkinson, who is also past president of the American College of Preventive Medicine, and former executive vice president and chief health and medical officer at Lumenos, a pioneer consumer-driven health plan, pointed to the recent National Health and Nutrition Examination Survey that found only 8% of the population eats five fruits and vegetables a day, doesn't smoke, spends 30 minutes on physical activity a day, and is within 5 pounds of their ideal body weight.
You might consider that too high of a threshold, but how many people even meet two of those healthy living ideals? Stop by your local breakfast joint and you'll see what I mean.
Chronic disease is costing healthcare and the American economy billions of dollars through direct health costs and reduced productivity costs. David Knowlton, president and CEO of the New Jersey Health Care Quality Institute and board member of the HealthWell Foundation in Gaithersburg, MD, told me preventable chronic disease costs $7.5 billion in New Jersey annually. Meanwhile, state health reforms would cost the state $1.1 billion. By simply reducing the numbers of people with chronic diseases, healthier Garden Staters could help cut healthcare costs without having to open their wallets.
This is not to bash Americans as gluttonous. Heaven knows I could drop a few pounds and devote more time to physical activity. But what's it going to take for Americans like me to actually become more active and care about our health? Sure, a diabetes or heart disease diagnosis would spark action, but by that point prevention is out the window and then it is all about changing gears to stop the progress of the disease.
The last major physical fitness craze was in the early-1980s when Olivia Newton-John and Jane Fonda hopped into their spandex and got Americans into the gym and into bad aerobics outfits. I hope we don't need a celebrity to spark a new fitness craze, but one thing is clear: Unless we get more of the population interested in their health, the trillions of dollars that will go to health reform won't stop the spiraling health costs.
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