Is There Room for Personal Responsibility in Health Care?

healthy familyMuch to my own surprise, I have largely stayed closed-lipped about the health care bill, town halls, and debates over these last few months. Part of the reason is that I have seen it mostly as a way to get health care to the under-insured and uninsured. Usually, health care is an area where I am vocal about the power and possibility of disease prevention. I want everyone to get on the “prevention bandwagon” and take steps today to be healthier – whether it is a community that secures funding to keep their pool and workout room open, or an employer who invests in “wellness” programs and health fairs, or families that decide to prepare a healthy meal at home and go for a walk together in the evenings.

There’s no doubt that the bulk of the nation’s health care costs are based on personal choices. Smoking, high blood pressure and being overweight are the top risks for early death, hitting more than one million early deaths each year, with physical inactivity, high blood sugar and alcohol use not far behind, according to an April study by the Harvard School of Public Health. The price tag for obesity has propelled to $147 billion a year, new government studies show, and smoking costs about $193 billion in medical expenses and lost productivity.

These are the facts. But what do you do about it? Do you continue with the “blame game” and make smokers and obese people pay more for health care? What if they can’t afford it? Is taxing caloric beverages really going to move the needle when we’re getting lost in a big haystack of health problems?

If there’s one thing I truly believe deep down it is that there is a significant gap in behavioral health education for all Americans. Yes, partly in the classroom and family living rooms, but other places too like the community, workplace, and doctors offices (when people get there). But the greatest gap continues to be how health insurance of today neglects people who want to work on their nutrition and eating behaviors by making it difficult for them to get access to preventative nutrition visits with a registered dietitian.nutritionist

I probably turn away 10 people a week who call me wanting a nutrition assessment but want insurance to pay for it. Well, insurance is really limited in what they cover and it is not preventative in nature. So a person needs to save and save just to see me or they go without it. What is frustrating is that people do try to take responsibility, but they need help and support. They need expert advice, answers and counseling.

At some point, when we discuss weight management and personal responsibility, we’ve got to be honest about lowering the barriers that get in people’s way of living a healthy life. Sometimes that’s things like cost of equipment, race registrations, and gym/yoga memberships and other times that’s the cost of getting some basic counseling for what they can do to improve their eating habits, how they can cook more at home even with limited time and skills, and how they can build healthy eating habits with their kids. Other times, it’s even more simple… do kids in low income neighborhoods have safe sidewalks and parks? What about low-cost grocery stores?

If people are going to change their lives and perform new, healthy behaviors they have to believe they CAN do it and get the support they need to make the right changes in a way that’s not going to totally disrupt their life. I’ve always been in awe of the Biggest Loser, for those few fortunate people to get the right environment and motivation to finally shatter their unhealthy shell and chisel out a new, healthier version of themselves. But how do you make The Biggest Loser scalable to everyone?

So, what do you think?  Should we be talking more about disease prevention or do you think talking about “healthy lifestyles” is just too much lip service to ever amount to any real change in the cost of health care in the U.S? What is your experience with your health care for weight management and smoking cessation? Do you have real opinions on the future of health care and the future weight of Americans?

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