Should We Continue to pay for Peoples Poor Health Decisions?

Don Ardell, self-styled guru and author of this famous line "wellness is too important to be grim about" states that no medical system can afford to pay for individuals who abuse themselves and refuse to make good decisions about their health. He writes, tongue-in-cheek, "let's encourage people to smoke, thousands will die yearly and then the taxpayers won't have to provide services to them in their old age!" His contention is that if people lived healthy lives they would live longer and conversely that would mean greater costs to the taxpayer. Dr. Ardell's weird slant on the financial advantage from poor health choices is the antithesis to the usual discussions of wellness and making good lifestyle choices. Most people want to live long and healthy lives, however, most people consistently make poor health decisions throughout their lives expecting the medical system to bail them out at the end. A little known statistic (so unknown I can't quote it verbatim or be certain of the source, although I do know that it came from an old Ardell newsletter column) is that in North America, we spend the highest percentage of medical costs during the last five weeks of a person's life. This would be called "after the fact" kind of thinking, not preventative thinking. This last minute, "heroic" procedure, which is incredibly costly, is applied, for the most part, to people who have already settled into the process of dying, it' s too late! As well, a very high percent (the statistic I have seen in print is 80%) are dying from lifestyle related illnesses; that means they had choices and probably have not made the best decisions about healthy living throughout their lives and are now paying the ultimate price. Should we not allow these people who are dying and have no chance for quality of life, to die? Invest the money saved (no heroics) and put it into prevention, education and awareness programs so as to encourage those still healthy to make good choices. As well, put money into quality of life (QL) programming for those who have made good choices and will live longer and healthier. Encourage people to live healthy and reward those who have.

"Heroics" or "Pull the plug" are certainly discussions we need to have with family members. Individuals need to have a say on what they want when their time comes. For me, QL is the standard by which 'live', as in live life to the fullest. Measure the success of your day by the QL garnered, rather than the length of the list of accomplishments. Similarly, QL should be the deciding factor of when we 'die'. What I mean is that we should be allowed to die without the heroics and without it being a legal/political decision. When the QL is gone from a person's life, they should be allowed to die. This discussion is not really all that controversial until we start to talk about 'who' should be allowed to make these life and death decisions, or we bring in religious dogma which in most cases doesn't allow for an individual position on this issue.

Another way of looking at health and wellness and the redistribution of the shrinking medical dollar, is to reward people who practice a positive, healthy lifestyle and to make those who are putting themselves at risk, accountable for their own medical costs. It's always been a mystery to me when we know unequivocally that smoking causes cancer why we would take care of the medical costs of the smoker, or for those injured on motorcycles and have not bothered to wear a helmet. These are choices people make. They have the right to make them, but by the same token, they have the right to be held accountable for their choices, and not expect the taxpayer to pay for their decisions. However, I guess this perspective could be used for a great many other medical issues as well and if applied too liberally could include most everything we need hospitals and doctors for.

An article in the magazine Business and Health prompted this entire tirade of mine. It seems that a small company, the A. E. Miller Meatpacking firm in Hyrum, Utah, decided not to pay for some medical procedures based on certain lifestyle factors of their employees. They stated that they would not cover medical costs if an employee was involved in an auto accident and was not wearing a seatbelt, or while 'driving under the influence'. If riding a motorcycle without a helmet - no coverage. If prospective parents do not attend pre-natal classes, they will not reimburse the cost of delivery, or baby's care in the hospital. They also are charging smokers significantly more for insurance premiums than non-smokers. Can they do this legally? Can they force people to make healthier life choices? Yes they can! It seems that they have been doing this since 1992 and health costs have dropped 20%. Eric Falk, Human Resource Director of A. E. Miller, states: "All we're going to say is that this is what we will pay for, and we will not pay unless certain pre-requisites have been met. The main thing is that we are not discriminating against anyone. We are requiring everyone to do the same thing."

My response is "what took so long?" I truly believe in stopping the flow of freebies to people who use the medical system to take care of their health instead of doing it themselves. Maybe if we tie responsibility for one's health more to that individual's pocket book, the person might begin to make healthier choices - maybe!

What do you think? Why not drop me a note and give a response and let me know where you stand: agree? disagree? I certainly don't have the picture from all sides.