Max C: Focus on prevention and individual responsibility

[maxc]

I tried and tried and tried, but I could not adequately address the issues of societal and individual responsibilities towards healthcare without looking beyond the realm of medicine, its finances, and its regulations. Working through this issue has convinced me that our government and media should do the same. I’m not suggesting that there is nothing to improve within the healthcare industry, but it appears that the most effective solution to the staggering costs of Americans’ collective medical care will address why so many people need these services rather than simply how we provide and pay for them.

Pardon the irony of the metaphor, but to look only within the systems of medical insurance and regulation to solve our society’s burdening healthcare costs is to treat symptoms without looking for a cause. But this should not be surprising. The established medical community itself is geared more toward alleviating symptoms and fixing problems that have already surfaced than it is toward preventative care or making lifestyle changes before pathologies develop.

Along these lines, it is heuristically safe to assume that it takes less effort to prevent a problem or catastrophe from happening than it is to reorder the ensuing chaos. An example: if one desires to keep a coffee mug functional and intact, it is easier to move it away from the edge of a counter or other dangerous areas than it is to mend it once it has fallen and shattered. This makes sense in a particular instance, but, played out over the life of a mug, the minimal effort involved in protecting the item requires sustained, disciplined effort and forethought, while the more epimethean solution won’t require a thought or care to enter one’s head until after the damage is done.

It is the choice between these two modes of health preservation that I place upon the individual. If a person’s longevity and well-being is not a priority for her and their actions reflect this, then I do not believe a government or society should be expected to make it a priority to fix the failing heart, liver, or lungs of an individual who has repeatedly, carelessly abused these organs. Where to draw the lines between “natural” and self-inflicted pathologies is too lengthy an issue to be dealt with here, but it would be a public debate worth having.

What this idea of an individual’s choice should tell the government is that the rhetoric and proliferation of social “safety nets” is likely futile and potentially dangerous. More efficient of time and resources would be a focus on providing a “foundation” for a healthy population to develop. Rather than catching people when they fall, a government should be spending more time helping people not to fall in the first place. To allow another bad metaphor into this discussion, the government should be teaching men to fish rather than giving them fish, by which I mean, help people to protect the organs they have rather than fixing or buying them new ones when they wear out. Teaching children to avoid refined sugars is much less costly than lifetime supplies of insulin.

Condensing what I believe to be an individual’s responsibility, the price of being a free individual is accepting responsibility for one’s actions and the priorities reflected in them. A person can choose to prioritize immediate pleasure over long-term health, and the freedom to make that choice is accompanied by its consequences, which can in fact be terrible.
For those more legalistically inclined, I believe that a government’s responsibility toward its population—my “foundational” approach—might look something like this:
(1) Providing a stable, safe environment with respect to violence, environmental hazards or contaminants, and working conditions.
(2) Education with regard to nutrition and health, which is supported by scientific data. (Would respectable nutritionists agree with our FDA’s food pyramid, which apparently tells me I should be eating more bread and pasta than vegetables???) Allow individuals to become responsible for themselves by making them aware or conscious of the health choices they will make.
(3) Perhaps to encourage healthy behavior when it becomes obvious that the first two measures are failing. (For example, “sin-taxes” on toxic ingredients and food products (think Twinkies and Cheetos), for example.)


Final thought: I apologize that I have avoided issues surrounding genetic or inherited ailments, for which I have no real solution. These maladies are not “chosen” in the sense that heart disease, forms of diabetes, and obesity can be, but it still does not seem right to place the responsibility of their treatment upon the rest of society or the government.

[caseyd]

I think this is a pretty thoughtful piece and I agree that we need to focus more on prevention.

But the individual responsibility argument can only go so far, because the healthy choices have to be there in the first place for individuals to make the choice. It's not just about education. It's about food systems and the built environment. People can understand that an apple is a better choice than a candy bar, but when the apple isn't available in the neighborhood or is priced more expensively than the candy bar, people have less incentive (or ability) to choose the apple.