Obstetrics & Gynecology in Augusta, GA

Is Health Care Reform Really Necessary?

    Health care reform is about as hot a topic as pepper sauce on Texas armadillo meat.  The pundits and politicians are bantering about like hens in a hen house clucking about this plan and that reform.  It is politically and philosophically prudent to be on the side of some type of change in the health care system.  No one disagrees that the system is unsustainable in its present configuration.  I concur that the situation is dire; the patient is in cardiac arrest and something has to be done.  However, I differ from many in believing that the solution is one that is simpler yet more impractical than a government take over.  I realize that sounds somewhat contradictory – simpler yet impractical – so let me explain.

    First, it is important to understand that we have two separate but intertwined problems: health insurance and health care.  As I am not an insurance expert so I will only opine about health care.  We will never cure this country’s ills without a strong dose of personal responsibility.  The government, politicians, insurance magnates, and even doctors are not only inadequate to change the system but incapable of effectively bringing about change because the change has to begin from within.  It has to come from the individual; the man in the mirror.  The biggest healthcare crisis in this country is not cancer, AIDS, heart disease or lack of insurance; it is people not choosing to live their lives in a healthy manner.  Until we as individuals start adopting the things we know to do to stay healthy, we will persist as a nation in need of sick care delivery instead of health care. 

Part of the problem is one of education.  For example, many feel that getting regular mammograms and doing self-breast exams are excellent preventive tools for breast cancer.  They are not!  They are simply tools of early detection. The cancer already exists when the utility of mammograms and self-breast exams are realized.  These tools prevent nothing other than higher morbidity and mortality, which is a good thing!  But we have to move back one level if we are to prevent breast cancer.  For example, decreasing your body mass index (BMI) a simple measurement that assesses your amount of body fat, can reduce the occurrence of breast cancer 40%!  Reducing obesity, stopping smoking, increasing your intake of fruits and vegetables, limiting alcohol intake; these are behaviors that all substantially reduce the likelihood that you will develop a breast cancer.  Are mammograms and self-breast exams important?  Of course, they are, but our focus should not only be on early detection but also prevention.  There are multiple factors that go into disease development, many of which we don’t understand.  My point is that, in general, a skinny vegetarian has a lower incidence of breast cancer than an overweight couch potato, and when you expand that to whole populations you begin to see how individual decisions can have a massive collective effect.

Another example from the field of women’s health is cervical cancer.  The Pap smear revolutionized the care and treatment of cervical cancer in the 50’s as it allowed for the detection of the disease in it earliest stages. As time went by and research progressed it became apparent that a major cause of cervical cancer is infection with the Human Papilloma Virus.  Pap smears can pick up changes in the cervical cells long before they develop as a cancer, but the Pap only detects the changes once they are there.   Two things can prevent HPV infection (and thereby most cases of cervical dysplasia): an HPV vaccine and monogamy.  Having multiple sexual contacts dramatically increases your risk of infection with HPV and thus greatly increases your risk of cervical dysplasia and cancer.  Again, prevention is different from early detection.  If you want to prevent cervical cancer, develop effective programs supporting vaccination, abstinence, and monogamy.  How many politicians are willing to handle that hot potato? 

     These are but two examples illustrating that the answer to our health care crises begins at home.  Providing health insurance to everyone will only reduce the number of uninsured, a noble undertaking, but it will do little to solve the problem of reducing and preventing disease.  At the beginning of this diatribe I stated that the answer was simple; personal responsibility.  I also said it was impractical.  An individual has every right to live the life they choose.  I have no moral authority to tell anyone that they must stop smoking, for example.  They choose their lifestyle, but they, in turn, must take responsibility for their actions.  Here is where the hypocrisy arises.  We clamor for personal rights but we cower from accepting personal responsibility.  Do we as a society have a moral imperative to take care of the sick and helpless?  Absolutely!  But that is paralleled by a moral responsibility of the individual to make decisions that improve their health.  I am my brother’s keeper, but in turn, it is my brother’s responsibility to not embrace behaviors that jeopardize his health and my good will.

    Will we ever be a society of both free will and moral accountability? We must if we are to survive this health crisis.