People get worked up over the topic of healthcare, a lot. But it’s a complex topic and even the name is wrong. It should be called “sickcare” because 99% of the emphasis has always been and continues to be on treating us after we’ve become ill. For all the talk of preventive medicine, what we always always default to is post-symptom treatment. But this is a topic we’ll look at in another article. For now, we’ll just use the term healthcare despite its inaccuracy.
Various nations have attempted to create various types of healthcare system. France lets you (more or less) choose your provider and then reimburses you for a percentage of the cost. The percentage varies according to disease type, treatment, and so on. The United Kingdom introduced a universal system where there is no payment at time of delivery; instead you pay for it with your taxes. In the United States of America, not surprisingly, the healthcare system is mainly designed to make intermediaries rich and few are overly troubled about actual health outcomes.
Healthcare is always, wherever you are in the developed world, a topic of great contention. Few people want to be ill and fewer still enjoy suffering when they believe that someone out there could cure them if only the system worked better. So governments try to fix things. The UK throws money and endless management consulting studies at the National Health System (NHS) in a desperate attempt to reduce patient waiting times and improve outcomes. The United States remains locked in an ideological battle between progressives who believe it’s relatively easy to provide healthcare for all and conservatives who fundamentally don’t like the idea of ordinary people getting the kind of attention currently enjoyed only by the wealthy.
Whatever your position on healthcare, a few things are generally left out of the discussion that are in fact central to the fundamental problem of how a society can provide adequate health services to its population without ending up spending its entire gross domestic product (GDP) on trying to meet everyone’s expectations.
Let’s step back and look at why a country needs some kind of system to address health issues so we can get a little clarity on the fundamentals.
Illness is bad enough of itself without the idea that you may end up losing everything — your home, your ability to buy food and clothes — because you become sick and you have to sell everything you own in order to pay for treatment. Furthermore, this type of scenario means that a lot of people will put off treatment until the last possible moment, which invariably will increase the difficulty and cost of said treatment. The economic cost to the nation of lost productivity and the human cost of destitution is cumulatively too great for any civilized society to accept.
If you doubt this, just think for a moment about the one area where healthcare systems actually do attempt to be preventive rather than palliative: vaccination programs. For the cost of a few cents and a few moments of an individual’s time, days and weeks of illness can be avoided by tens of millions. The benefits are literally incalculable while the costs are negligible. No parent in the West today need worry that their precious offspring will die of measles or smallpox because vaccinations are cheap, reliable, and ubiquitous — at least in civilized nations. In the USA, which is the most backward rich nation, the anti-vaxxer movement is slowly eroding the efficacy of herd immunity and formerly vanished diseases are making their inevitable comeback. This ought to be a lesson to the rest of us about the perils of letting dangerous misinformation spread merely so that large US corporations can benefit from boosted advertising revenues.
Preventive treatments aside, the major problem for all healthcare systems is the one that no politician is willing to talk about: the problem of unlimited demand. Yet until we address this issue no healthcare system will ever meet public expectations and misallocation of resources will continue.
Here’s the basic problem: resources (medical personnel, medicines, equipment, facilities, money) will always be limited. Yet demand will always be almost unlimited. All healthcare systems, whatever their ideology, have to face this fundamental fact. No matter how much you tax your citizens and corporations and no matter how much money you may temporarily be able to borrow on the bond markets, eventually you will reach a limit while demand for services will invariably continue to increase.
Some countries try to solve this problem by prioritizing treatments and making people wait in a queue. This is in general the approach taken by the UK’s NHS. The problem is that the queues become longer and longer and the queues vary by region. Mary may find herself being told she has to wait three years for a hip replacement while her friend Sally who lives just a few miles away but in a different NHS administrative region only has to wait eighteen months, which is unfair. And of course British governments periodically spasm with terror as voters complain about the length of the queues so they set incentives for the NHS to reduce queue time, which results in distortions that cause other problems elsewhere — this is the so-called “ironing the wrinkle” problem where applying pressure in one place merely moves the troublesome wrinkle to a different location.
Other countries try to solve the problem by using cost. Thus in the USA the healthcare system delivers adequate results provided you have plenty of money; otherwise it is a total catastrophe. The Affordable Care Act made a terrible situation even worse (which was quite a triumph in its own perverse way) by increasing the average person’s cost (higher premiums, higher copayments) while reducing the average person’s coverage in order to provide subsidized coverage for those on low (or no) incomes. In order to prevent the intermediaries (the large insurance companies) from lobbying to block the AFA, the Obama administration agreed on a formula that would actually increase their profits. And so the USA has a healthcare system that is explicitly designed to ensure money flows from people to insurance companies rather than directly to the healthcare providers, which means of course that everyone is paying $1 to get $0.70 worth of benefits.
While the USA has the worst possible combination of elements, the underlying problem remains the same: supply will always be limited while demand will always be nearly infinite. So tinkering around the edges isn’t going to address this fundamental problem. Making stirring political speeches during election campaigns isn’t going to address this fundamental problem. Throwing more money at the system isn’t going to address this fundamental problem.
The fundamental problem is us.
In the USA today around 85% of the population is overweight. In the UK the figure isn’t much lower and it’s rising. Elsewhere, even in countries like France, people are getting fatter every year. There is irrefutable evidence that lack of exercise coupled with poor diet results in all manner of chronic health conditions. Today, most healthcare systems use more than half their resources attempting to ameliorate the consequences of people’s poor lifestyle choices.
Let’s think about that for a moment: in the USA your healthcare premium could be significantly less if it weren’t for all the expenditure on obesity-related illnesses. In the UK the time you have to wait for treatment could be significantly shorter if it weren’t for all the effort spent on obesity-related illnesses.
Although British people famously adore their NHS regardless of political persuasion, the hard fact is that they are the very ones causing it to collapse under the weight of unnecessary demand. Although US citizens clamor for more affordable healthcare, to a large degree they are the ones creating the costs that lead to coverage being so outrageously expensive.
No politician is ever going to point out this simple fact because no politician can get elected if they look voters in the eye and say, “You’re the problem.” We all want someone else to solve the problem, someone else to pay the price of our indolence and self-indulgence. And we most definitely do not want to be told that we should take personal responsibility for ourselves and make more adequate lifestyle choices. Especially as most of us don’t have the necessary willpower.
If we are unable to make better lifestyle choices for ourselves, what else can be done? Well, if we go into pretty much any store these days, what do we see? Piles of junk food everywhere. Today in far too many countries we can buy junk food practically anywhere: in a sewing store, in a gasoline station, in a hardware store, and in a sporting goods shop. When we go into a supermarket we see entire aisles crammed with junk. In fact, in most supermarkets more than 75% of the items on display are actually unfit for human consumption because of their adverse metabolic effects. Yet these things are readily available and promoted across a wide range of media as being desirable. It is highly unlikely, however, that any country will attempt to limit this avalanche of junk. That would be “interfering with consumer choice” and large corporations would launch lawsuits and massive public relations campaigns to defend their right to profit from slowly killing their consumers. It took Western governments fifty years to try to reduce rates of smoking; we can imagine it would take centuries to attempt to reduce rates of junk food consumption.
This means we will continue to be surrounded by junk.
The only other course of action would be for governments to structure healthcare delivery so that it rewarded good lifestyle choices. This could be done in the UK by prioritizing people with illnesses that are unavoidable and making those with obesity-related illnesses wait in the queue. So Janet would get her hip replacement quite quickly but Jim, who is sedentary and obese, would have to wait much longer to see someone about his aching knees, his bad back, his high blood pressure, and his fractured ankles. In the USA this type of structured delivery would mean higher premiums for people who are obese, have high blood pressure, and don’t exercise, while those who make more adequate lifestyle choices would enjoy lower premiums.
Of course no politician will ever risk antagonizing 85% of the voting population with such measures, so this type of cost-benefit solution is also infeasible.
As there are therefore no large-scale structural fixes and as no politician will tell us the truth about ourselves, the only solution to the healthcare crisis lies in our own hands. And that in fact is very empowering. Instead of poisoning ourselves with sweet salty fatty preservative-laden junk, instead of cramming endless McSlop into our mouths, instead of slumping indolently on the sofa for hours in order to stare vacantly at a screen, we can refuse to continue to self-harm. This is an immensely powerful course of action.
When we stop eating junk and we start to exercise, a number of amazing and wonderful things begin to happen. We start to sleep more soundly and wake more refreshed. We have more energy. We feel happier. Our thinking becomes less cloudy. Those aches and pains begin to vanish. And we are far, far less likely to become ill. Oh, and yes, we’ll also lose weight and stop looking like sacks of whale blubber.
Why don’t more people look after themselves and reap the many benefits? Largely because we’re hardwired for very good evolutionary reasons to be as idle as possible. Largely because we’ve told ourselves we should have endless “rights” but no concomitant responsibilities. Largely because it’s so much easier to make endless excuses: “I don’t have the time,” “I’m so exhausted when I get home from work,” “I can’t afford to eat healthy food,” “I have a bad knee,” “I tried a diet once and it didn’t work,” “I’ve read there’s no connection between being obese and being unhealthy,” and on and on and on.
But these excuses rob us of the power we can have over our own lives. It’s like throwing your car keys out the window and then saying morosely, “I can’t use the car, I don’t have the keys.”
It’s time we stopped pretending we can’t do anything about our own health. It’s time we stopped pretending we have a “right” to self-harm and then expect someone else to fix the damage we’ve done to ourselves. It’s time we took responsibility for our own behaviors.