There is plenty wrong with Healthcare in the US, but Obamacare (regardless of how you voted or what you believe politically) is not the whole problem. It’s not the solution either but this is not meant to be a political blog. Like one of the adverts on television for a new drug that has a very long list of side-effects, The Affordable Care Act does some good and some harm. If there is a problem with it, it is that it has distracted us from what the real problem in healthcare is.

Now there are many symptoms of the illness that is our healthcare system. Yes, under- or un-insured are on that list but so are costs, regulation, special interests, pressure groups, trial attorneys and so on. The issue is that none of these are the problem either.

The real problem in healthcare in the US is the patients.

Quality of Life

For the first time in history the next generation may live shorter lives than their parents and grandparents. We are becoming less healthy by the year. This is probably no surprise to most of us and there has been no end of TV news reports of the growing obesity of the population. This does not just come from what we eat, it also comes from how we live. From the day we picked up the remote control (rather than tasking the youngest in the house to change the channel) we started to swap doing the right thing for our bodies with doing the convenient thing for our lives.

We sit in front of the television for 5 hours because we have had a long day on our feet and we are just too tired to think about anything else. We fight for the closest car parking space to the supermarket rather than waste time walking a few more feet. We drink the sugary drink because we prefer the taste. We eat the fast-food because we are short on time and it’s nice not to have to get out the car. And now, we even want that cars to drive themselves. We seem to be on a non-stop search for convenience.

The problem of course is that while we probably know our behavior will have a long-term effect on our lives, it’s hard for most of us to quantify it. Plus, the fact that all the advice we get seems to be contradictory. No-butter, now no-margarine. Salt is out, now it’s back again. Milk is bad for you but yogurt is ok – if you eat the right sort. That cigarette or the next Krispy Kreme will take 5 minutes off our lives, so how do we process advice like that? I know I should exercise more or better but what exercise makes a difference?

This is hard enough for someone that is fit and healthy, but imagine what it means to someone who is chronically ill with something like Type II Diabetes? A disease, like most, made worse by the life styles we live.

The Real Problem with Healthcare

Every 20 seconds someone in the US is diagnosed with Type II diabetes. That’s about 1.7m Americans every year.

However, let’s not confuse Type I and Type II diabetes. You can find a good summary of the difference between the two at the WebMD site. The key impact for most people is that Type I is typically a medical condition that can be managed but not prevented. Type II can, WebMD says, “be prevented or delayed with a healthy lifestyle, including maintaining a healthy weight, eating sensibly, and exercising regularly.”

In fact, the World Health Organization estimates that much of Type II diabetes and 80% of all heart disease, and strokes, as well as more than 40% of cancer, would be prevented if Americans would stop using tobacco, eat healthy and exercise regularly. In the context of the US, that means of the $3 trillion plus we spend on healthcare each year, $2 trillion is spent managing disease that may be reversible or at least avoidable. In addition, we are also spending over another $2 trillion buying all those cigarettes, hamburgers and other conveniences that cause much of the problem.

Yes, healthcare is running out of money but it’s not just because of the underinsured or uninsured. It’s not even because of all the regulations, pressure groups, trial attorneys and other special interests who use their power to disrupt the system. The reason we are running out of money is that we are spending 80% of the money on fixing what should not be broken.

The impact of this spending is also felt by people with non-life style related conditions. How much of their pain and suffering could be reduced if we didn’t spend 4 out of every 5 dollars on people who were fundamentally the cause of their own illness? Anything we could do to repair this problem would have a massive effect across the whole system.

I would not advocate for the ‘non-treatment’ of people with self-inflicted chronic conditions any more than I would suggest we should not treat people who broke a bone skiing. “It’s your own darn fault” does not seem a sensible or humane approach.  But we clearly need to do something.

It’s all in the way you see it

At the heart of finding a solution to a problem is always some agreement on what the problem actually is. While that might sound obvious, it clearly can’t be. People who don’t want cancer still smoke and those with diabetes still eat too many unhealthy carbs. So why do people do things that are bad for them and what can healthcare do better to stop them doing it?

All good questions and I will try to cover some of the answers in my next blog.