America’s Health Care Crisis: Part 1.  Whose responsibility is it anyway?           

As “Health Care Reform” careens down an unknown path in the Congress, let us spend a few moments to analyze how we got into this mess.  Americans spend $2.4 trillion a year on health care. The Business Roundtable reported that in 2006, Americans spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.

In a different twist, the report took those costs and factored benefits into the equation. It compared statistics on life expectancy, death rates and even cholesterol readings. The health measures were factored together with costs into a 100-point "value" scale.

The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.  The cost-benefit disparity is even wider -- 46 points -- when the U.S. is compared with emerging competitors: China, Brazil and India.

So, how did we get here?  There is plenty of blame to go around, including lawyers, insurance companies, doctors and we, the people.  This series will assess the role of each segment.  First, let us look at our role as consumers and see how our behavior has contributed to this mess.

A few months ago, one of my neighbors (lets call him Q) was driving to New Jersey on I-78 when he began to feel unwell.  He felt weak and nauseas, and had a headache.  Q managed to work half the day, but then his condition deteriorated.  After calling his wife, he drove home, without informing his physician about his condition.  The wife waited at home, wondering whom she would hear from first – her husband, the emergency medical services, or the highway patrol.  He did end up reaching home safely, without causing a wreck or injuring other drivers on the highway, but they ended up going to the emergency room that night.

The story gets more fascinating at this point.  After many tests in the ER, Q was hospitalized.  He had a history or high blood pressure and was about 100 pounds overweight.  Disregarding his doctor’s advice to loose weight and exercise, he had carried on, concluding that he was too young to worry about strokes or heart attacks.  After all, he was only in mid-thirties.  But Q wasn’t too young, and he ended up with a stroke.  Fortunately for him, there was no permanent neurological damage.  Unfortunately for him, the tests revealed another problem – he had a mass in his neck that was detected by computerized axial tomography (commonly known as the CAT scan).  That it required a CAT scan to identify a mass that should have been detected by a physical exam is a point that will be addressed in a subsequent column, but to cut a long story short, he was suspected of suffering from a lymphoma.  Many tests followed, most of them unnecessary, with attendant expenses and anxiety, till he was proven to be cancer free.  And then, Q lost his job.  While the company laid-off others as well, undoubtedly his case was complicated by medical bills.  A few months after this, I asked Q what medications he was on, and he looked at me with a vacant expression and said, “I don’t know.”  He now has trouble finding a new job that is commensurate with his experience and training.  Part of the reason is the health care premium his new employer would have to pay.

This story reveals several aspects of what is wrong with the health care system, such as the attitude of patients, doctors, lawyers, and insurance companies.  This column addresses the behavior of patients.  We in America have gotten used to being taken care of by someone else and over a period of time, have lost the sense of responsibility. Health has become the responsibility of everyone but the patient.  However, shouldn’t health the patient’s own responsibility?  Why should the government or a doctor be responsible?  A doctor IS responsible for providing guidance and counsel.  However, the ultimate responsibility is that of the individual.  And if that individual chooses to live on a diet of hamburgers, fries, and considers watching sports on TV the best way to exercise, is it a surprise that obesity, diabetes, hypertension, and heart disease ensue?  While suing may enrich a lawyer and provide a sense of satisfaction in retribution, it won’t solve the problem. 

Avoiding disease should be the first health care priority and responsibility of an individual.  That includes proper diet, exercise, vaccinations, and common sense actions such as wearing helmets, seat-belts, avoiding unprotected sex, etc.  However genetics, age, and environmental influences affect even the appropriately behaved persons, and that is where the second priority comes in. 

The second health care responsibility is to understand and educate oneself to disease(s) that afflict a person and also to familiarize oneself to the therapeutic modalities.  If an individual has hypertension, s/he needs to know the therapies available.  Unlike Q, who did not his medications, a responsible individual should not only know the names and doses of the medications but also the side effects and interactions with other medications.  In the Internet era, knowledge is not hard to come by and lack of access is no longer an excuse. 

The third health care responsibility is to follow instructions meticulously.  If exercise is advised, it should be followed.  If an antibiotic is prescribed, it should be taken as prescribed, and not stopped half way through. 

By taking responsibility for our own health, we can save the health care system from a catastrophic breakdown.