Why personal responsibility won't fix healthcare

In the continuing debate on health care, we hear a lot of terms thrown around, terms like "death panels" and "public option" and "pre-existing condition." I am all too familiar with these terms (especially the third one), as well as one other term that has been increasingly used as our country tries to figure out what the bleepity bleep to do about health care. That term? Personal responsibility.

An op-ed piece in Newsweek by Jeneen Interlandi addressed this idea head-on.

If I develop diabetes or cancer or cardiovascular disease, I will undoubtedly add to the nation's health-care burden. But my behavior is only one in a host of factors that will determine whether any or all of those conditions eventually befall me. In fact, a rapidly growing body of evidence indicates that how much education, income, and social status people have, what's advertised on the billboards or sold in the stores around them, and how clean the air they breathe and streets they walk on are kept, have as much to do with their health as diet, exercise, and doctor's appointments. "It's the context of people's lives that determines their health," says a recent World Health Organization report on health disparities. "So blaming individuals for poor health or crediting them for good health is inappropriate."

Now, I'm not anti-personal responsibility. I'm not saying that this is a green light to velcro ourselves to the couch and eat Ho-Hos all day. But "choosing health" isn't as straightforward as it might seem. How can you eat properly when many major cities have large food deserts? When it's not safe to play outside? When there isn't a good place to play even if it was?

Nor do we have good ways to accurately measure "responsibility." As long as you're not a smoker and your weight is in the "normal" range, congratulations, you're "healthy" and "responsible."

Writes Interlandi:

Consider the most oft-cited source of our national health-care woes: type II diabetes, triggered by obesity. My food choices alone should make me a prime candidate for both. But I am 5'3" and I have never weighed more than [redacted] lbs. I'd like to take credit for showing restraint at the pastry shop, but the truth is, I have no restraint. What I do have is a lightning-quick metabolism acquired through a twist of genetic fate. In fact, twists of genetic fate have a significant influence on who develops not only diabetes but a range of chronic diseases...

...Of course none of this information will stop people from blaming the less healthy among us. When we say that people fall ill because they eat too much, drink too much, work too much, or don't sleep enough we are also saying that by not doing those things we can avoid the same fate. Blaming the individual gives us a sense of control over an uncertain future. It's also easier than contemplating our own mortality.

Benjamin Franklin said that the only certainties in life are death and taxes. Well, Mr. Franklin, illness is almost certainly a third, and we're just going to have to live with that. Prevention is good, but people are always going to get sick. Blaming the sick isn't going to make them any healthier.

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Special K said...

Great post...have you read the book Hungry? There is this notion that we can manufacture ourselves, that we are limitless...but we have to accept our limits in order to be human. To be fully alive.
Sorry I've been MIA...would love to hear from you

marcella said...

Yes, great post. It reminded me of a talk I went to by this guy http://www.markvernon.com/
Very inspiring but no source of easy answers for Church, State, Medics or Insurance Companies.

Kim said...

I get really irritated with the idea in this country that people are sick because of some defect within their willpower. Just yesterday, I heard a radio show describing any addiction or chronic condition (like an eating disorder) being for "weak-minded" people. This societal perception really doesn't help matters in the health care debate.

Anonymous said...

Great post, Carrie. But I think the death and taxes quote might be from John Maynard Keynes.

Anonymous said...

Horrors, I was wrong, and you are right! It was Franklin.
(Correcting myself is one habit that I have learned in the years since having an eating disorder. Being impulsive, i.e., not checking facts first, is one bad habit I've never been able to quell.)

Crimson Wife said...

Yes, genetics play a role and one's environment can make it harder to maintain a healthy lifestyle. But ultimately the choice does lie with the individual. I make a conscious effort to avoid demonizing foods; however there are definitely items that should be reserved for occasional treats rather than being dietary staples.

Can someone make all the right choices & still get sick? Of course. But he/she has a much lower risk of it than an individual making poor lifestyle choices.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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