Posts Tagged ‘Health Insurance’
Now that “Obamacare” has become the law of the land and the political disputes over healthcare reform are largely settled, many Americans are worried about the costs of the new insurance policies, especially considering the dismal health status of millions of our citizens.
“Why should we pick up the tab when so much disease in our country stems from unhealthy behavior like smoking and overeating,” asked one commentator in the New York Times. I’m sure such sentiments are widely shared. Many Americans would welcome higher premiums for those who indulge in unhealthy lifestyles, thereby punishing them for their lack of personal responsibility.
“But personal responsibility is a complex notion, especially when it comes to health,” says Dr. Sandeep Jauhar, a cardiologist and director at the Heart Failure Program at Long Island Jewish Medical Center in New York. “Unhealthy habits are one factor in disease, but so are social status, income, family dynamics, education and genetics. […] When people advocate the need for personal accountability, they presuppose more control over health and sickness than actually exists.”
The same goes for those who enjoy excellent health. Their advantages are not based on virtue alone. A report that was commissioned a few years ago by the Robert Wood Johnson Foundation, titled “Reaching America’s Health Potential,” concluded that the greatest differences in people’s health status are determined by their education levels, which, of course, also reflects to a large extent socio-economic differences. Even life expectancy is affected by educational standards, one study found.
Education is a marker for an array of opportunities and resources that can lead people to better or worse health, says Dr. David Williams, the staff director of the commission tasked with the report. A good education can offer greater job and career opportunities, higher income, more meaningful and creative work, a wider social network and support system. And access to healthcare is more likely.
When the sociologist Robert K. Merton of Columbia University first coined the term “Accumulated Advantage,” a.k.a. the “Matthew Effect” (taking the name from the Gospel of Matthew, verse 25:29), he described these dynamics as applicable to nearly every part of our lives, including our health.
Getting an education, and particularly health education, is not necessarily a matter of formal learning. It starts in the home, in early childhood. If healthy eating is encouraged, if food is valued, if sharing meals is a part of family life, chances are a solid foundation is laid for a lifetime of nutritional wellbeing. The same applies for physical activity and weight management. One leads to the other. Conversely, if fast food and pizza are the usual choix du jour, if smoking, drinking or drug abuse are considered acceptable behavior, if exercise is rare or nonexistent, then the consequences are predictable from the start.
But let’s be honest. There are poor eating habits, but there are also food-deserts where nutritious food is hard to come by. There is lack of exercise, but there are also not enough safe sidewalks, bike paths and public parks in low-income neighborhoods. There are dysfunctional families, but there are also countless parents working sometimes multiple low-paying jobs while desperately trying to provide their kids with a sense of home.
Universal health care must address all these issues, not just in terms of giving access to treatment for everyone who needs it but, even more importantly, in terms of preventing illness as much as possible. We cannot afford less.
If you liked this article, you may also enjoy reading “What Your Neighborhood Says About Your Health.”
Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com. For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com). You can follow Timi on Twitter and on Facebook.
It shouldn’t come as a big surprise. On average, Americans are in poorer health and have shorter lifespans than the citizens of other affluent countries, including most Western European nations, Australia, Canada and Japan. Considering that close to 50 million people, almost 20 percent of the population, are without health insurance and many more with only limited access to medical services, a decline in public health would seem inevitable. Still, the findings of a recent study by the U.S. government are quite shocking.
According to the Institute of Medicine (IOM), America currently ranks at or near the bottom among the 17 richest nations in the world in terms of life expectancy and chronic diseases like heart disease, lung disease, obesity and diabetes as well as injuries and death from violence and sexually transmitted diseases.
What’s even more disturbing is that these statistics not only apply to the poor and the elderly, as experts long expected, but across all demographics, including young adults and those who can afford health care coverage.
“We are struck by the gravity of these findings,” said Dr. Steven Woolf, professor of medicine at Virginia Commonwealth University and chairman of an expert panel that was tasked with the study. “What concerns [us] is why, for decades, we have been slipping behind.”
Even first generation immigrants coming to the U.S. show negative health effects within a relatively short time due to diet and lifestyle changes. According to the National Institute of Health (NIH), obesity rates among immigrants roughly equal those of U.S.-born adults within 10 to 15 years after taking up residence here. One study found that migrants from comparatively poor countries like Mexico or Guatemala are especially prone to develop diseases like obesity, diabetes and heart problems because of dietary changes.
“If you go with the flow in America today, you will end up overweight or obese, as two-thirds of all adults do,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC) in an interview with USA TODAY. “Obesity is one of the few things that has gotten worse quickly. It really is a very serious health problem,” he added.
The obesity epidemic is also one of the main reasons why it is so hard to get health care costs under control in this country. It costs $1,400 more per year to treat an obese patient compared to someone who is normal-weight and $6,600 more to treat a diabetic, said Dr. Frieden.
What changed in the U.S. more profoundly than in other countries – although similar trends are now emerging worldwide – is a dramatic shift in our eating habits. We eat more conveniently prepared but highly processed foods and enjoy fewer healthy meals made from scratch. Our portion sizes have gone through the roof. We also have become more sedentary due to progressive automation in the workplace, longer commutes and lack of safe outlets for physical activity.
“What has happened is that the structure of our society has changed in ways that make it difficult to maintain a healthy weight,” said Dr. Frieden. It’s a fertile ground for the diseases we now see on an epidemic scale.
Obviously, there is not one solution that could undo all of these regrettable developments. Multiple measures will have to be put in place and made to work together. Personal responsibility is certainly part of the equation, but so are numerous other components such as better health and nutrition education for the public, further improvements to school lunch programs, reintroduction of mandatory physical education (PE), more effective safety and disclosure regulations of agricultural and food manufacturing industries, to name just a few.
The current deterioration of our public health is not irreversible. On the contrary. Most of our ailments are self-inflicted and therefore in our control if we only muster the will to address them in meaningful ways.
Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.”, and at amazon.com. You can follow Timi on Twitter and on Facebook.
Soon the U.S. Supreme Court will decide whether making healthcare coverage mandatory for all Americans is constitutional or not. The principal question is whether the government should have the power to make people buy a particular product – in this case health insurance – regardless whether they want it or not.
Opponents of the new law argue that once Congress can force people to get insurance, it can make all sorts of other requirements as well, if it deems them necessary. Eventually, so the argument goes, this could lead to a future scenario where everyone will be required to eat healthy (e.g. lots of broccoli) and forego simple pleasures like smoking and drinking. So, beware of the “nanny state” before it’s too late.
The fact is that most Americans have been subject to a mandate to buy health insurance for a long time. It’s called Medicare. Contributions to the program are automatically deducted from people’s paycheck, whether they eventually will reap the benefits or not. That’s as mandatory as it gets.
In truth, it is quite clear that there are limits to what the government can do, says Einer Elhauge, professor of law at Harvard University and director of the Petrie-Flom Center in Health Law Policy. “If [Congress] tried to enact a law requiring Americans to eat broccoli, that would likely violate bodily integrity and the right to liberty. But the health insurance mandate does not require Americans to subject themselves to health care. It requires them only to buy insurance to cover the costs of any health care they get.”
But what about the private sector? Is it acceptable, for example, that employers coerce their workers into adopting healthier lifestyle habits, like asking them to quit smoking, exercise regularly and manage their weight?
More and more companies now require employees who smoke, are overweight or have high cholesterol to pay a greater share of their health care costs. According to Mercer, a consulting firm specializing in corporate health policies, about a third of companies with over 500 workers offer wellness programs and give other incentives like insurance discounts. But others, including industry giants like Wal-Mart, Home Depot, PepsiCo, Safeway, Lowe’s and General Mills have chosen a more punitive approach, they describe as “more stick, less carrot.” Wal-Mart, for example, demands “surcharges” of up to $2,000 per year for smokers among its workforce. Others set “health targets” that employees must meet to qualify for lower premiums. Those who fail to meet specific standards may be charged 20 to 50 percent of their policy costs.
Critics say that practices like these are thinly disguised ways to discriminate against less than perfectly healthy workers. Some people suffer from health problems that are not necessarily lifestyle-related and may not always be under their control, they say.
That may very well be. But tobacco users alone consume about 25 percent more health care services than non-tobacco users, according to Greg Rossiter, a spokesperson for Wal-Mart. “The increase in premiums […] is directly related to that fact,” he added.
The message is clear: If we are to succeed in making health care more accessible and affordable, we all must do our part. The employer-based insurance system we have now is not sustainable in the face of ever-rising costs. Nor is a private insurance industry that remains out of reach for tens of millions of Americans.
The Obama administration has emphasized from the start that affordability is an essential component of any health care mandate. But affordability depends in large parts on responsible use. We have a national health crisis on our hands with two thirds of Americans being overweight and one third being obese. We have a childhood obesity epidemic never known before in history. We have an array of lifestyle-related illnesses like diabetes, heart disease and cancer that could mostly be avoided with healthier diets and exercise.
“No longer can the public afford a system that shifts the burden of care for the uninsured onto those who have health insurance or onto the fragile health care infrastructure we have,” said Dr. Charles P. Mouton, professor at Howard University College of Medicine and chairman of the Department of Community and Family Medicine. Instead of accepting the fact that millions of our citizens seek routine medical care through hospital emergency rooms, we need to build a system that promotes health and wellness for all. At the same time, nobody should consider good health as a purely personal matter that is nobody’s business but his or hers. We all have a civic duty to maintain our health as best as we can and not unnecessarily burden society with the consequences of poor lifestyle choices. Only then we can hope to finally achieve a health care system that is just, viable and can be embraced by all.
Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.