The Occasional Random Thought…

There’s a lot of discussion beginning to percolate in health policy circles on how the creation of “wellness incentives’ could create a financial loophole in the healthcare reform legislation. If it isn’t clear to everyone, we have a major problem with lifestyle issues in this nation such as smoking and obesity.  These problems begat problems such as heart disease, diabetes, cancer, and a whole variety of lifestyle diseases.  And, these issues are problems of consumption – or the environment – and not genetics.   As an overseas ex-patriot returning to the from a two year stint in , I can tell you that the differences in physique between the rest of the world and the are stark and contrasting.  While the folks living in my home base of are not knights in shining armor when it comes to exhibiting healthy behaviors, I will tell you that even the novice observer can see the distinct differences, for example, in obesity. 

While some are critical of healthcare reform efforts that include the wellness incentive programs – I applaud them.  First, I support them as a physician, but as importantly, I support them as a person who has walked in the moccasins of these problems.  I cast the first stone because I have been there. 

Until Dec. 17, 1981 at 11:32 pm, I smoked four packs of cigarettes a day!  Imagine?  No, don’t!  It was pathetic.  I had cigarette smoking stains on all of my fingers.  I could barely walk up a flight of stairs.  I was only 30 years old!  I quit because of crushing chest pain – at an early stage of my life – when I could beat the problem.  I’ve been smoke free since that time (…exactly), and you don’t want to be around me with a cigarette.  Apologies for those who do smoke, but I’m an evangelist on this front.  But, it doesn’t stop there… 

Five years ago on Dec. 16, 2004 (yes, the day before I quit smoking – 23 years later), I had bariatric surgery because I realized I was “fat.”  I went from nearly 400 pounds at the time of surgery to my steady state of 171 pounds today.  I had developed diabetes, hypertension, and all sorts of other problems which totally disappeared when I lost the weight.  Not only that, it’s clear to me that I’m treated much differently as a more svelte person than as a fat person despite having the same perspective, the same voice, and the same attitude I’ve developed over 58 years of life.  I was clearly on the road to going over the edge…

So, what’s the message?  I believe if we don’t push our society to become healthier, we are missing a real opportunity.  We have all of this discussion about the need to prevent insurers from using pre-existing conditions as a pro forma for rejecting us as part of our national insurance policy, and I agree with that policy position.  Yet, we don’t look in the mirror.  I do believe we can do better.  As a society, those of us on the receiving end need to do something as well.  We can’t sit passively on the sidelines expecting that our health will be provided at our beck and call.  Rather, we need to step up to the plate –or perhaps, step away from the plate. 

If we don’t accept the challenge, we simply add expense to the cost of healthcare for what purpose?  Isn’t it time we engaged consumers in helping to “manage” and “direct” their health by taking responsibility?  Yes, there are issues we need to consider so that individuals with legitimate problems are not disenfranchised, but if we – as individuals – want to engage in destructive behaviors, we need to understand the consequences.  I’m not suggesting that people should do without.  Rather, I’m suggesting that penalties work.  I can tell you that crushing chest pain works in incentivizing someone to quit smoking!  I can tell you that bilateral stress fractures in my feet helped me realize that I wasn’t a “big boy.”  Rather, I was “fat.”  And, I can tell you that the cost of continuing those behaviors in terms of healthcare consumption and loss of productivity – to say nothing about impact on family are huge.  The cost of having bariatric surgery was significant because I had to reach into my own pocket, but it pales in comparison to the burden on society I would have become with chronic diabetes and hypertension to say nothing of the other associated problems.  The cost of quitting smoking was well, money in my pocket.  I quit. Everyone should be so lucky.  Some need help.  Others don’t.  Still, we should help everyone…

It seems to me that if we can take a long-term, decade long perspective on the cost of health insurance – we should be able to take a similar perspective on how to foster a healthier society.  So, why do we need to do this?  Because our society can’t afford not to do it!  Today, the media is awash in news on the $1.4 trillion (yes, trillion) federal deficit.  While reckless spending on the part of both sides of the aisle has contributed to the problem, healthcare costs are the singular most expansive element of cost for both the federal and state governments.  We need to do something not only for today but our legacy – our children and our children’s children.  Isn’t that our responsibility as a compassionate society?  Shouldn’t we make a difference by making us better?  We can do better…

So enough of the rants.  I’ll keep them to a minimum.  But, we need to move on from insurance reform to healthcare and societal reform.  As always, more later…

Kevin Fickenscher, MD

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Services or its affiliates.