We must first look to ourselves to reduce healthcare costs

Awful Truth #3: We can greatly reduce healthcare costs in the United States if we choose to do so. 

The current healthcare system in the United States leaves people justifiably terrified they won’t be able to afford care for themselves or loved ones.  It is a dreadful fear to worry that you or a family member could die or not be able to live life to the fullest because you can’t afford treatment for a serious medical condition.  Financial ruin is a risk: A large percentage of personal bankruptcies are due to a serious illness or injury and the unfortunate person or family was uninsured or underinsured.  As a society, we must do better.  

Healthcare costs in the United States eats up a huge share of our gross domestic product (GDP) when compared to other countries.  Many countries have a universal healthcare or single-payer system that typically consumes far less of their GDP than does our current hybrid system, which is a mishmash of medical care provided by the government, for-profit entities, and charities. 

Though many Americans are satisfied with their current healthcare, which is typically private health insurance largely paid for by their employers, there has long been talk about adopting a single-payer healthcare system in the United States. Such a system already exists in the form of Medicare for senior citizens. Most of those enrolled in this program also express satisfaction when polled.

It must be noted that adequate coverage for those enrolled in Medicare requires a supplemental insurance plan, so Medicare is in reality a hybrid of single-payer and private insurance. Without this supplemental insurance, Medicare enrollees may find themselves inadequately insured.

We have a healthcare system that works well for most of us, so why change anything? This is certainly one option, but it does not address the fundamental concerns about the current system; specifically, (1) millions of people are uninsured or underinsured and (2) it is unstainable, based on both demographics (an aging population) and relentless cost increases that typically outstrip the rate of inflation or employee wage gains.

There exists a miasma of widespread anxiety about healthcare, even for those with health insurance or Medicare. I feel it myself, despite having affordable employer-paid coverage. Skyrocketing costs have shifted more of the burden on employees who face an increasing employee-paid share of the insurance premiums. With job insecurity and the fear of layoffs comes the ever-present terror of losing one’s health benefits, especially if a person is already caring for a sick child or spouse. Medicare recipients worry about being able to afford their Medicare co-pays unless they can also buy a good supplemental plan, and the cost of these plans is increasing. These concerns, in theory, would be eliminated by a true single-payer system with no or minimal co-pays.

We must understand that single-payer systems are not perfect. They also aren’t cheap and governments that provide them must continually work at prudent cost containment, though the expenditure per person is significantly less than the amount spent per person on healthcare in the United States. It’s possible such a single-payer system won’t provide the same level of service as the adequately-insured currently receive.  There could be longer waits for medical services or certain services may not be available. An examination of countries with universal healthcare shows such drawbacks could indeed result should we choose to implement universal healthcare here.

These are legitimate concerns, but we must also consider the benefits of a single-payer system: It would eliminate the link between employment and health insurance, prevent financial ruination for millions of people, provide care for the currently uninsured, and allow GoFundMe to be used for worthy causes other than helping people pay their medical costs. If a single-payer system in the United States is somehow able to provide us with care comparable to that many of us currently receive and expand this to include all Americans, it would be a good thing.

There is little doubt employers would love to rid themselves of directly paying for and managing their employee health plans. Employer-paid health insurance is an administrative burden for any business which provides this benefit. Warren Buffet recognized the extent this can reach, especially for a large company, when he said, “GM is a health and benefits company with an auto company attached.”    

Considering the pros and cons, it’s not wrong to want the United States to adopt a universal healthcare system.  Neither is it wrong to have a contrary opinion.  It’s a worthy discussion.  One we must have.  

But it must be an honest discussion. Brutally so.

The fundamental problem with the notion of universal healthcare in the United States—and which is never talked about—is there exists no affordable healthcare system, government run, private, or a combination of the two, that can accommodate the poor decisions and lifestyle choices made by far too many Americans. Not only as a society must we do better, but as individuals, as well.

It’s human nature to blame others for problems of our own creation.  There is shared blame here.  High healthcare costs in the United States are not exclusively the result of inefficiencies, fraud, or the profit motive associated with the healthcare-industrial complex.  These ruinous costs are to a large extent the result of self-inflicted injuries and maladies, which are largely preventable.

Am I victim blaming? In the aggregate, regarding healthcare costs in the United States, yes. The victims (us) are co-conspirators with the medical-industrial complex in fostering a ruinously expensive system.  

When I was in college a hospital administrator came to speak to our bioethics class.  He said if everyone gave up smoking and drinking, we could close half the hospitals in the United States (this was pre-obesity epidemic days).  Years later I shared this with my personal physician, and he added our present obesity crisis to the mix of causative factors. A fat drunkard who smokes doesn’t just harm himself; he is more likely to use a disproportionate share of healthcare resources over his lifetime, which costs all of us.          

The fact is we can greatly lower healthcare costs and make it far more affordable for most, if not everyone.  Such a result, a veritable healthcare cost Manhattan Project, can be done with nary a physicist or mathematician.  No rocket scientists are needed because there’s no rocket science involved.  This can be done irrespective of the means our society chooses to provide its citizens healthcare.  All it requires is that each of us do our part, which is to take personal responsibility for our own health and heed the below suggestions.  

Here goes:

• If you smoke, stop.  If you don’t smoke, don’t start.  This includes marijuana.
• If you’re overweight, lose weight and keep it off.  The “healthy at any size” claim is bullshit.  (The only way to lose weight is to eat fewer calories and be more physically active—there is no other way.)
• If you’re sedentary, become more physically active. 
• Exercise.
• Don’t do drugs.
• Don’t drink alcohol.  If you do, always do so in moderation.
• Unless you want to have children, use birth control when you have sex. 
• If you’re not having monogamous sex (with a partner who is doing likewise), use a condom and regularly get tested for STDs.
• If you have diabetes or high blood pressure, follow your doctor’s advice.
• Get recommended health screenings.
• Wear a hat, sunscreen and sunglasses when outside.
• Brush your teeth and floss regularly (at least twice per day).
• If you’re around loud noises, wear hearing protection.  This includes concerts and the workplace.
• If you’re around an activity that poses a risk to your eyes, wear eye protection.
• Follow workplace health and safety rules.
• If you own firearms, be a responsible owner.  I recommend a firearms safety class be offered on a voluntary basis (and with parental consent) in high school, whether or not a person owns a gun.
• If you’re so emotionally weak that you need a comfort animal, snap out of it.  (I’m not sorry to say that harshness is sometimes a necessary medicine, and not just regarding healthcare.)
• Eat sensibly.  A well-balanced diet with everything in moderation.  Dietary fads do not qualify as “in moderation.”
• Never drive after consuming alcohol or using drugs.
• Never get in a car driven by someone who’s been drinking or using drugs.
• Wear sensible, proper-fitting shoes.
• Wear seatbelts and obey traffic laws.
• Get vaccinated against the flu every year.
• Get a pneumonia shot.
• Make sure your kids are vaccinated against diseases for which there is a vaccine.  Keep your own vaccinations current.
• Learn and use good lifting techniques when moving items.  (Seems like something worth teaching kids in PE class, as well as the workplace.)
• Don’t play football or box. (These sports cause physical damage with life-long consequences.)
• Follow common sense safety rules when recreating (e.g., if you’re on a boat, wear a goddamned life jacket).
• Eliminate safety and fire risks around the house.
• Kid-proof your home against hazards (e.g., chemical storage).
• Wash your hands after using the restroom.
• Learn to swim.  Teach your kids how to swim.
• Support sanitation efforts related to food, water, air, solid waste, and vector control.
• Don’t do stupid shit (e.g., selfies with wild animals at Yellowstone Park, fraternity hazing rituals).

(I’m not a doctor, so check with your healthcare provider for other things you can do to both improve and maintain a healthy lifestyle.)

Yes, it’s completely within our power to greatly lower healthcare costs, if everyone does his or her part. You’ve likely already heard most, if not all, of the above suggestions. Maybe you read these and thought to yourself, “No duh.” No duh, indeed.

The prospects of a single-payer system are greatly improved, should we as a society choose to implement one, if we become a much healthier population. In fact, any system is more affordable, including ones that make sure the currently uninsured or underinsured have access to adequate healthcare.

I can do better. We can do better. We must do better. Collectively and as individuals.

But are enough of us going to follow this advice in order to significantly lower our nation’s healthcare expenditures, regardless of the means of providing it (status quo, single-payer, or other)? I don’t know the answer to this question, but I do know that failing to do so, we as a society fully deserve the healthcare mess in which we’ve long found ourselves, including the exorbitant costs and tragic inadequacies.