Being a Health Citizen

April 21, 2010

When I began this blog in January 2009, the focus was exclusively on providing my personal perspective on individual wellness. After years of following a different path than the mainstream, I found I was spending a fair amount of time sharing my viewpoints with people who were struggling with various health-related issues. I decided I’d begin to put all my thoughts on these matters in one place.

As the white-hot conflagration of issues related to health system reform raged in the US in 2009, I acquired an almost insatiable appetite for learning more about the complex issues facing US health care. For my regular readers, it may not be a surprise to you that I forged a point of view that might be considered a league apart. Not that I found no merit in the various points of view being expressed, but that I found each perspective having fairly major flaws that seemed obvious to me.

For example, those who hew to the idea that ‘free market’ mechanisms are the optimal way through which we obtain the best value out of our healthcare system don’t seem to notice that ours is the most profit-oriented system in the entire industrialized world and we spend more per capita (by a long shot) than anyone else. Wouldn’t those in law enforcement consider this a clue? To dismiss the variance by touting the ‘additional costs’ of world-leading medical breakthroughs in medical devices and pharmaceuticals begs the question ‘To what end?’ – given the well-documented paltry outcomes (overall morbidity, infant mortality, life expectancy, etc.). Also, while you could make a theoretical argument that pharmaceutical company, medical device and hospital profits lead to better care (by enabling investment in better approaches to care – I am not convinced), I have yet to see a single remotely defensible argument that links insurance company profits to improved health outcomes.

Still waiting.

Conversely, those who tout ‘single-payer’ as a cure-all do so, it seems to me, as a matter of faith. Setting aside the political and economic obstacles in the way of instituting a ‘single-payer’ system in the US, I’ve yet to see a cogent explanation as to how single-payer in and of itself transforms healthcare. Yes, it would certainly increase access to medical care, but it is no solution at all to ensuring that said access is sustainable for the long term. My other problem with ‘single-payer’ is more ethereal. I just have an aversion to mono-culture. It seems to me that we need an approach that is not just functional for now, but also sustainable and adaptable over the long term. A diversity of approaches is needed in order to achieve that end. I’m not convinced a single approach to funding the entire system would give us that adaptability. We will still need to innovate as time moves forward and the best way to enable innovation is to have a diversity of ideas that would not be fostered by a single-payer approach.

So, over the course of many months, I mulled whether I would begin to use these pages as a vehicle to express my thoughts on broader health policy issues in addition to the health/wellness topics I started off with. Finally in January 2010, I made some initial, tepid steps. But it still lacked coherence. Am I touting myself as a health policy wonk type? (a mini-Uwe) Am I advocating on behalf of a specific, well-established point of view? (well, I guess not, if I’m saying that all of the major entrenched positions have significant flaws). It finally occurred to me the role I was taking on was that of a ‘health citizen.’ Citizen in the most active and broadest sense of the word which encompasses being an informed and active participant in the political, economic and social life of your society not as a self-appointed ‘expert,’ but as a private citizen very focused on pushing us to deliver value out of every element of the system.

So, what does it mean to me to be a ‘health citizen?’

  • While this is readily obvious, it seems to continually get lost in the debate: health care and medical care are not interchangeable. In fact, if we were to assign a percentage impact of medical care on the overall health of society, it would constitute no more than 15% of the total. What are more important are the social determiners of health: clean water, sanitation, protection from toxins, good education, nurturing human interactions. The extent to which we lay the burden of health care on those who deliver medical care we feed into the monster that has become the medical-industrial complex. A health citizen understands this distinction and acts accordingly.
  • Each of us needs to take personal responsibility to use medical care resources thoughtfully and judiciously. We must begin to think of our medical care resources in a similar way to our natural resources. These services have now become part of the ‘commons’ we all share. Consuming an inordinate amount of these resources out of fear or simple entitlement furthers the ‘tragedy of the commons’ to which citizens will not contribute. It has also been well demonstrated that more medical care is not necessarily better medical care. A health citizen uses only what he or she needs even to the point of questioning the need for things that their care provider recommends.
  • In a direct tie-in to the wellness thrust of this blog, to the extent we can improve our own health, the easier it becomes to be an asset to the health of our society as opposed to a liability. It seems very odd to have to point this out given that one would think the primary incentive for making healthy choices is to, well, be healthy. It is apparent, however, that many millions of us continue to make choices we all know to be detrimental to our health. This is exacerbated by the bankruptcy of the conventional dietary (low-fat/high-carb) and exercise (chronic cardio) wisdom that is detrimental to many millions more who are acting on this disastrous advice and believe they are doing the right thing for their health. A health citizen takes part in bringing forth the new conventional wisdom.
  • Engaging with others is obviously a central part of being human. A health citizen participates actively in a community that supports each other in pursuing better personal wellness in addition to pursuing better health for the broader society.

This whole idea is a work in progress and I’d be interested in your thoughts about it as I hone this into something that can make a difference.

Thanks for getting through this one, I know it’s long!


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