There Are Two Kinds of People in the US – Those Who View Health As Static and Those Who Don’t

Introduction: We’re Not #1

I believe Americans need a new way of thinking about health. Look where our current perspectives on the subject have gotten us – we are last among the world’s 17 most industrialized nations in all the key indicators of health. It’s hard to believe but true: we’re last in life expectancy; we have the highest rates of obesity, infant mortality, low birth weights, heart disease, diabetes, chronic lung disease, homicide rates, teen pregnancy and sexually transmitted diseases.

The lead author of the Institute of Medicine, NIH sponsored study that revealed this situation remarked that “Americans get sicker, die sooner and sustain more injuries than people in all other high-income countries.” (That’s a quote from the report.) Then he added this coup de grace: “We were stunned by the propensity of findings all on the negative side – the scope of the disadvantage covers all ages, from babies to seniors, both sexes, all classes of society. If we fail to act, life spans will continue to shorten and children will face greater rates of illness than those in other nations.”

Two Ways to Think of Health

I believe Americans are overly passive about their health. Good health can only be attained and maintained by conscious deeds. These deeds require planning and disciple. Examples include exercising regularly and vigorously, dining in ways that nourish the body without causing problems and otherwise behaving in positive, active ways.

The level of health you will enjoy is clearly affected by your lifestyle choices. Your health status depends to a great extent on whether you invest in your well being or not. If you make little or no such investments, your health will depend on chance, genetics, the aging process and the timeliness of the quality of medical care you receive.

If, on the other hand, you do invest, if you seek, protect and defend an advanced state of well being, the nature of the health status you will have will be dramatically different – and better.

Therefore, we need to distinguish these two kinds of health situations – one passive, one active.

The Institute of Health report that places America last reflects that segment of America that is passive. If the quite small segment of the American population that practices active health were separated, if their health data were compiled and compared, I’m sure we would be #1.

For these and related reasons, I propose we view health in two different ways – by making a distinction between static health – which is how most view and approach their health, and earned health. The latter is what you get when you invest wisely in your own well being.

It’s a way of life I call REAL wellness.

Health As Currently Perceived

The WHO definition of health is unrealistic (nobody, not even the most devout wellite, enjoys “complete physical, mental and social well-being,” at least not every day). Most think of health in far less exalted ways. Most think they are well if they are not sick. This is pathetic. It equates with not needing immediate medical attention. For the vast majority, this is a “good enough” view of health. Thinking that way is a self-fulfilling prophesy. It means that not healthy is the best you can hope for. This is the static definition of health and it must be reformed and at least accompanied by another, comparison perspective for those Americans willing to do their part. That would be earned health.

I think we need ideas about health that remind people of a key fact, namely, that a passive situation is not as effective, desirable, protective or rewarding as a dynamic earned state of health. We should all be aware that static health, the default setting you get for just existing and doing nothing special to enhance health, can and must be reinforced and boosted.

Employing a term like earned health might remind people that health can be much more than non-illness. The term earned health can signal the availability of a richer level of well being. It can remind everyone that health at its best is more than a static condition. Health is a dynamic state; it gets better with effort, worse if ignored.

Health Care Reform – Why Are People So Worked Up?

Why are Americans so worked up about health care reform? Statements such as “don’t touch my Medicare” or “everyone should have access to state of the art health care irrespective of cost” are in my opinion uninformed and visceral responses that indicate a poor understanding of our health care system’s history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let’s try to take some of the emotion out of the debate by briefly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let’s look at the pros and cons of the Obama administration health care reform proposals and let’s look at the concepts put forth by the Republicans?

Access to state of the art health care services is something we can all agree would be a good thing for this country. Experiencing a serious illness is one of life’s major challenges and to face it without the means to pay for it is positively frightening. But as we shall see, once we know the facts, we will find that achieving this goal will not be easy without our individual contribution.

These are the themes I will touch on to try to make some sense out of what is happening to American health care and the steps we can personally take to make things better.

A recent history of American health care – what has driven the costs so high?
Key elements of the Obama health care plan
The Republican view of health care – free market competition
Universal access to state of the art health care – a worthy goal but not easy to achieve
what can we do?

First, let’s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

To begin, let’s turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail’s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

Let’s skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a “wait and see” approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

This very basic review of American medical history helps us to understand that until quite recently (around the 1950’s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; “nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor’s offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the “perfect storm” for higher and higher health care costs. And by and large the storm is only intensifying.