Thursday, August 13, 2009

Shifting the Blame for Lack of Reform to Where it Belongs

We have met the enemy, and he is us.


Nine of the ten leding causes of death in the United States are preventable. One one of ten, diabetes, is an inherited disease; all the others are affected much more by what we do than who we are. And since diabetes can often be controlled by diet, wieight loss, and exercise, it is fair to say that changes in the American life sytle could help control all of the ten leading American “death styles.”

Harvey B. Simon,MD, Saying Well, 1992

We dig our graves with our own teeth.

Benjamin Franklin

Keep moving!

Alistair Cooke, The Patient Has the Floor, 1980

The mind works in mysterious ways. Who to blame for U.S. health reform problems came to me in the middle of the night? The answer was: Us!

We cannot blame government. Government can only make pronouncements and policy decisions. Goverment cannot eat our food or walk our walks.

We cannot blame private health plans. They can only help pay for the ills we have brought upon ourselves.

We cannot blame the pharmaceutical companies. They can only supply the pills to correct our self-induced metabolic dysfunctions.

We cannot blame the medical device industry. It can only create and build the half-way technologies that prolong our lives.

We cannot blame the doctors. They can only diagnose and treat the ailments that inevitably come upon us.

So who to blame?

We can blame our culture – our automobile-dominated society, our sedentary life-style, our slothful sitting before flickering TV and computer screens, our lack of sidewalks and footpaths, our addiction to fast foods, our aversion to fresh foods and vegetables, our proclivity to drugs and alcohol, our turning away from the problems of poverty, our failure to comply with medical advice, our neglect of our environment infrastructure, our dependence on medical technologies to save us from ourselves.

We can blame our lack of reliance on “social system engineering” – universal coverage, comprehensive integrated care, preventive programs, our all-inclusive, ubiquitous interlocking high tech information networks.

These things help, but they will not save us from ourselves.

They will not save us from the burdens of obesity – which now accounts for $ 147 billion of of health costs – and contributes so heavily to the big killers – coronary artery disease, heart failure, hypertension, stroke – or to smoking – the main cause of chronic obstructive lung disease, which accounts for another $100 billion of health costs.

No, for these health problems, we have only ourselves to blame. medical care make up only abut 15% of the health of any nation. life style for 20% to 30%, and other factors – poverty, violence, crime, corruption, inferior education, income differences, and lack of social cohesion for the other 55%.

Lack of universal coverage, limited government regulation, social injustices, and racial biases may contribute to ill-health, but only marginally. And though our miraculous of medical technologies may prolong our lives, restore our function in the end, they cannot fully restore health and forestall death.

So reform yourself. Watch what you eat, go for a walk, weigh yourself. check your blood pressure and cholesterol, take your medicine, relax, and enjoy your limited time on this good earth.

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