Reader Response – Lifestyles and Cost

A reader takes issue with something I said on the radio today:

I just heard you make a point on Pete Dominick’s show, but I hope you’ll be a bit more precise in the future, because (I think) it’s important.

What you said, citing the example of the caller who is a vegetarian and runs 50 miles per day but still has a cholesterol count of 400, that “It’s just not true” that peoples’ personal habits (eating, exercise etc.) is a cause of high healthcare costs in the US (or anywhere else presumably).  You said that the caller makes this clear, because some people, like him, will get sick even if they do all the right things.

But to say “Some people will get sick no matter what, so therefore it’s not correct to argue that a solution to healthcare costs increases is to make people behave better”, which is what I heard you imply, is not accurate either.

There are of course two issues.  One is whether individuals are somehow responsible for their own illnesses.  The answer is USUALLY not, so we ALWAYS have to err on the side of treating people for illness regardless of what someone might say caused the illness.  This is I think what you were trying to say.

But the other issue is AS A SOCIETY, can we influence healthcare costs via lifestyle changes.  The answer most likely is YES, WE CAN.

I think you would do us all a service by not conflating these two issues and categorically saying “It’s not true that peoples’ bad habits are a cause of high healthcare costs”.  While it’s certainly true that if no one ever ate at McDonalds people would still get sick, it’s also true that if everyone ate at McDonalds all the time healthcare costs would  certainly increase.

I wish I could go back and listen, but that’s not possible right now.  If I said that “people’s personal habits are not a cause of high health care costs” then I apologize.  I meant to say that”people’s personal habits are not THE cause of high health care costs”.  I also don’t think that I said that “people will get sick no matter what, so there’s no reason to make people behave better”.

Look, the first part of what I was saying can be summed up here.  It’s a common argument, and I think a flawed one, to say that the high health care costs in the United States are the fault of the American people and their lifestyle.  I also think that there is plenty of evidence that most reasons for the high cost lie elsewhere.

Moreover, I don’t think getting people to behave better is a bad idea.  I made a strong case on the show for a better public health infrastructure.  I just don’t think that getting people to behave better will necessarily reduce costs for society.  There’s an argument to be made that getting people to behave better will make them live longer and therefore cost MORE over the long term.  Not necessarily, but it’s possible.  I think we should encourage people to be healthier because it’s an outcomes good (definite) not because it will save money (debatable).

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