Health care, not just sickness care

Health care reform should have two goals: to make health care cheaper, and to make health care better.  These goals seem contradictory, but really they’re not.  The apparent contradiction is because the reform debate isn’t really about “health” care, it’s about “sickness” care. It’s about managing the cost of treatment when something goes wrong.  True “health care” starts before that, by leading the sort of life that reduces your need for medical treatment.

Cheaper sickness care is only a component of a more effective health care plan.  Complete health care involves managing:

• Diet
• Exercise
• Stress
• Your environment
• and only then, if necessary, sickness care

“Sickness care” reform is important, since sickness care spending is the biggest component of government spending. But managing sickness care costs is only a portion of improving health care.  If our health improves, our sickness care costs will go down since we’ll require less of it.  Can the government do more to help?  Should the government do more?

The diet issue consists of two parts.  First and foremost, people need to get enough food.  Government has a role there directly by providing assistance to the poorest people and indirectly to the extent government manages the economy to reduce the number of the poor.  Only after you have enough food can you begin to think about whether you’re eating the right food.  Government could have an indirect role there, encouraging healthy eating by a system of tax credits for healthy food or surcharges for junk food.  But no one really wants the government cast in the role of mommy, watching over what you eat.

The proper amount of exercise can have a positive impact on health.  Not enough exercise and you’re weak and prone to obesity and all that entails (heart disease, diabetes, high blood pressure, etc…).  But too much exercise can also create problems, by driving stress levels up too high or by causing injuries.  Again, government can have an indirect role, by supporting the costs associated with athletic facilities or allowing tax credits for the purchase of exercise equipment.  We could also choose to tax equipment for activities that discourage exercise, like videogames , televisions, books, or other passive forms of entertainment.  But no one wants the government to manage our lives at that level.

Excessive pollution will definitely detract from your health.  Ask the people who lived in Love Canal or Three Mile Island.  Pollution has been shown to contribute to all kinds of problems.  The government has a definite role in regulating pollution.  The trick is to balance the need for a healthy environment against the economic damage caused by costs associated with complying with regulations.

High levels of stress can cause all kinds of physical issues.  The government’s role in managing stress is indirect, but multi-faceted.  Given the government’s power and central role, everything it does has an effect on our quality of life.  But stress is an area where the individual can do more to help himself than the government can, whether by meditation, moderation, or just by cultivating a positive attitude towards life.

Most people would resist the level of government intervention into their personal lives necessary to manage all facets of health care (though many people (bloggers, for example) are perfectly willing to tell others what they need to do). Government has a big role in managing sickness care costs, but that’s only a small part of the total health care package.  Preventative measures are important too.  The government’s most effective role may be providing the information necessary to help people make the best choices for themselves. In the end, if people want better health, they need to take responsibility for their own health care.