The current political discussions on health care seem to be taking us down the path of a government-run single payer system, ostensibly to help more people. This is a dangerous path that we are being led down by a group of politicians that are neither expert in health care nor well versed in human behavior.
It appears that politicians offering to give away more “free” items than their opponents is a technique that never goes out of style. Furthermore, the items considered to be “rights” seem to be ever expanding, ignoring that in a free society we are born with certain inalienable rights and that we are free to work and provide our families with the rest.
These politicians also ignore historical lessons provided by the many regimes which collapsed in the search for Utopia, the most significant lesson being that more government equals less liberty. We all agree that we should provide health care benefits to those people who cannot provide them for themselves, however a discussion regarding how we define “unable to provide” would be worthwhile. I believe most Americans would agree that an adverse health care event should not cause financial ruin, therefore, our collective goal should be “How do we implement a health care system that allows affordable, high quality care that does not limit a patient’s choice of providers?”
The answer is not Medicare for all or some other government single payer system. One can look to our friends to the north and in Europe for reasons why. All government-run systems eventually lead to rationing of care, less patient choice and increased costs. The Affordable Care Act (ACA) is proof positive of this. Remember the sales pitch for the ACA: “You can keep your insurance and your doctor; health insurance prices will drop.” These things turned out not to be true. Health insurance premiums have doubled in many cases. Government-run health care systems also inhibit research and development in health care.
Furthermore, single payer systems ignore facts and basic economics: 75 percent of health care costs in the US are for preventable diseases, to which diabetes and cardiovascular disease are the most significant contributors. Study after study shows us that human behavior (what we consume and how much we move) is the largest indicator of health and related costs. In the health care arena, behavior leads to risks, and risks will eventually lead to disease processes (if the risks are present for long enough). We also know that many risk factors can be reversed with the appropriate behavior. Therefore, if we change the behavior of human kind, we change the world. This should lead to a logical question: What motivates human beings to change their behavior?
Politicians seem to ignore the effects of human behavior when writing legislation. The expanding welfare state is evidence of this. When there is a government program that offers something for free, humans will modify their lives in order to “qualify” for the program. In this way, good intentions by politicians have a negative effect on the very population they seek to help. As the government increases aid for more basic human needs, the desire to develop human capital by those accepting aid decreases. This is true not only in the United Stated, but anywhere it has been implemented. Continued development of human capital is the only pathway into higher economic brackets, a better life. The evidence is clear that humans are motivated by a few things. I believe these motivations ultimately can be categorized into three columns: hope, fear and financial incentives. I have seen this time and again in my own practice. A patient changes their own behavior when a loved one experiences a catastrophic health care event, like a heart attack. The family member fears having a similar event, therefore they alter their dietary and exercise habits.
I have given these events a name. In fact, it is the name of my book and I use the term when I lecture; “Wellness Wake-up Call.” Most Americans are aware that obesity, smoking, lack of exercise, and a multitude of other behaviors are dangerous, yet it takes a catastrophic event of a family member to bring it to our consciousness.
I am not suggesting that fear be a part of our health care system, however, hope and financial incentives should be. Indeed, these are the only things that will lower costs. Making health care free for everyone is unaffordable. Current Medicare expenditures are too high, and the choice of providers is dropping for economic and other reasons, i.e., many doctors opt out of Medicare due to the paperwork and low pay. Additionally, the vast majority of Americans have health insurance provided by their employer and were happy with their coverage before the passage of the ACA.
The way forward is to reward positive health behavior and restore the financial relationship between the health care provider and the patient. The latter, step one, is essentially restoring the principles of capitalism to the health care arena. Far too many patients don’t ask how much it costs for a procedure or office visit because we think someone else is paying for it. (insurance company, Medicare, Medicaid) This results in reduced pressure on providers to keep their fees reasonable and affordable. This could be solved with a choice of high deductible tax-free plans that allow patients to control their care. It also provides a financial incentive; If you don’t spend the money you get to keep it. Plans like this ensure that a bad health care year will not financially ruin a family.
Step 2 is rewarding positive behavior and outcomes. These parameters can easily be set using biometrics like BMI, blood work, and tobacco use, as well as physical challenges. The latter can be achieved by setting categories for age appropriate timed walking/running, biking distance challenges, as well as strength challenges, while offering discounts on insurance premiums for those that achieve the goals.
Research has confirmed that low fitness is the single largest risk factor for an early death. Some politicians have suggested confiscatory taxes on unhealthy food and drink items, much like we have taxed tobacco. This is not a good idea for several reasons. First, in a free society one should be able to consume (legal) substances whenever desired. The caveat is we must deal with the consequences, meaning there is a health — and therefore a financial — risk in doing so. If we remove the financial risk, we will never change the behavior. Second, the government currently uses tax revenue from cigarettes to pay for health care costs in some states. As a result, the government has a vested interest in citizens continuing to smoke, because if cigarettes sale tax revenue decreases, less funds are available to pay for health care costs. This is a dangerous dichotomy.
Freedom isn’t free. The burden of freedom is dealing with the consequences of our behavior. We should provide a system for insuring those that are not capable, however we define this. If we are going to control costs and still offer the best health care in the world, as well as choice of provider, we must harness and apply what we have learned over the past two centuries about human behavior.
Dr. David Barczyk is a Healthy Living Analyst and FOX News contributor. Has done dozens of interviews with radio and TV stations across the United States . His topics include motivational healthy living guidelines that are educational, entertaining and empowering. He has also discussed the economic impact of unhealthy lifestyle choices on individuals, communities, states and our country. He is the author of the book “Wellness Wake-up Call” and operates six Chiropractic wellness clinic locations in South Louisiana. Details: www.Barczykwellness.com