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Why personal responsibility won't fix healthcare

Posted Oct 31 2009 11:00pm
In the continuing debate on health care, we hear a lot of terms thrown around, terms like "death panels" and "public option" and "pre-existing condition." I am all too familiar with these terms (especially the third one), as well as one other term that has been increasingly used as our country tries to figure out what the bleepity bleep to do about health care. That term? Personal responsibility.

An op-ed piece in Newsweek by Jeneen Interlandi addressed this idea head-on.

If I develop diabetes or cancer or cardiovascular disease, I will undoubtedly add to the nation's health-care burden. But my behavior is only one in a host of factors that will determine whether any or all of those conditions eventually befall me. In fact, a rapidly growing body of evidence indicates that how much education, income, and social status people have, what's advertised on the billboards or sold in the stores around them, and how clean the air they breathe and streets they walk on are kept, have as much to do with their health as diet, exercise, and doctor's appointments. "It's the context of people's lives that determines their health," says a recent World Health Organization report on health disparities. "So blaming individuals for poor health or crediting them for good health is inappropriate."

Now, I'm not anti-personal responsibility. I'm not saying that this is a green light to velcro ourselves to the couch and eat Ho-Hos all day. But "choosing health" isn't as straightforward as it might seem. How can you eat properly when many major cities have large food deserts? When it's not safe to play outside? When there isn't a good place to play even if it was?

Nor do we have good ways to accurately measure "responsibility." As long as you're not a smoker and your weight is in the "normal" range, congratulations, you're "healthy" and "responsible."

Writes Interlandi:

Consider the most oft-cited source of our national health-care woes: type II diabetes, triggered by obesity. My food choices alone should make me a prime candidate for both. But I am 5'3" and I have never weighed more than [redacted] lbs. I'd like to take credit for showing restraint at the pastry shop, but the truth is, I have no restraint. What I do have is a lightning-quick metabolism acquired through a twist of genetic fate. In fact, twists of genetic fate have a significant influence on who develops not only diabetes but a range of chronic diseases...

...Of course none of this information will stop people from blaming the less healthy among us. When we say that people fall ill because they eat too much, drink too much, work too much, or don't sleep enough we are also saying that by not doing those things we can avoid the same fate. Blaming the individual gives us a sense of control over an uncertain future. It's also easier than contemplating our own mortality.

Benjamin Franklin said that the only certainties in life are death and taxes. Well, Mr. Franklin, illness is almost certainly a third, and we're just going to have to live with that. Prevention is good, but people are always going to get sick. Blaming the sick isn't going to make them any healthier.
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