Health Care Reform Healthy Living

No skin in the game..

Nearly every day an email comes with medical news and it is truly remarkable how many repetitive studies are done, which show adherence to the usual lifestyle factors, diet, exercise and cessation of smoking improve outcomes.

This past week the Go Red for Women Hearts is yet another proclamation, specifically to women, to get with it and live healthy.

This morning the news wires reveal an 18,000 person multi-country study which shows that post-ACS (Acute Coronary Syndrome -medical speak for heart attack or near heart attack), risks of cardiac events were dramatically reduced in patients who adhered to lifestyle modifications.  Go figure…Yet another of the hundreds of studies involving many thousands of patients which all reveal that heart disease remains one of the most preventable and modifiable life-altering diseases.

A quote from an AHA spokesperson hits the highlight,

“This study is consistent with other studies that show improvement in cardiovascular risk profiles with lifestyle counseling. However, the biggest problem is not so much our beliefs in reducing risk for cardiovascular disease though participation in modification of lifestyle, it’s really getting the patients to participate in their care and actively lower their risk factors.”

Some facts…

-Cardiac rehab reimbursement is reduced.
-Physicians consultation fees are reduced.
-“Squishing” or bypassing blockages remains well reimbursed (albeit less so now).
-Patients remain without any incentive to comply, other than old-fashioned motivation, which works in about a third.   The smoker who refuses to quit, pays the same for subsequent heart care than the motivated, and indeed if the deductible is met, future care is “free” later in the year.

Heart disease prevention and the resultant lowering of health care consumption is right there in front of us, and anyone who can see, read and hear knows this.  It is also clear to any master of the obvious, that the present paradigm of “recommending,” smart choices but paying for the treatment of poor choices is not working. 


2 replies on “No skin in the game..”

I think you have illuminated what is certainly the most difficult issue in our Healthcare system. Although, for me, it raises more questions than answers.

Is it ethical, constitutional, or even possible to charge different rates for healthy vs unhealthy patients?

Can we, or should we, try to force healthy decisions? To what extent?

How do we win the war against Heart Disease and the American culture of obesity?

I don't know, but a little diet and exercise would go a long way.

A quandary indeed.

It is politically incorrect to suggest that we even consider modifying behavior with financial means, so I will only think to myself; the notion of taxing cigarettes and alcohol at higher rates. Or, charging taxes on high fructose corn syrup products or even more sacrilegiously ponder the idea of medical care being more like dental care in which one pays for services with "real" money, rather than insurance money. No, I did not say these things, just thought them.


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