Preventable Chronic Disease

The United States cannot drive down the cost of health care if nothing is done to address preventing many of the preventable chronic diseases that account for a large percentage of the health care costs in this country. According to the CDC "The medical care costs of people with chronic diseases account for more than 75% of the nation’s $2 trillion medical care costs". Lifestyle choices result in many preventable chronic diseases, and result in the associated medical care costs. The prevention of these chronic diseases cannot be medical intervention alone, but must include lifestyle change if health care costs are to be driven down. None of the health care reform proposals being considered address encouraging life style change, or penalizing poor choices with respect to one's health, and perhaps they should not. But without such changes, won't health care costs continue to rise? So, should the legislature attempt mandate personal responsibility? Can it?

Issue with Comments - Hopefully Resolved

Hey Tonya, I noticed that there was no way to respond to your posting with a comment.  I went into the system and made some changes, and it looks like new posts may allow that, but something must have been temporarily reset to prevent it. 

Will another bureaucracy be better?

Michael you act as if a public option is the only solution to this problem. A public option is not the only solution to the problem your friend's patient faces, and, in fact, it may not be a solution at all - a government option can, and probably will deny coverage in certain cases as well. It is likely that today your friend's patient can appeal the insurance company's denial, and it is likely the appeal can be "fast-tracked". If he does not have this option today, regulations can be changed such that patients have a recourse when coverage is denied. To answer your FB response, "The difference between non-medical people making treatment decisions in a public system vs. our current profit-driven system has to do with the fiduciary responsibility of the decision maker. In a public system, that duty is to the patient, rather than the company shareholder." I don't find your argument persuasive. Just because an insurance company has a duty to its shareholders does not mean that it cannot also have a duty to those people it covers. In fact, insurance companies do have that duty. All companies serve multiple stakeholders. And many insurance companies serve their customers and shaeholders well (a large percentage of people with private insurance are very happy with their insurance companies). Regarding the insurance company's denial of your friend's patients colonoscopy - I don't have enough information to determine if I would agree or disagree with the coverage denial. Perhaps there are alternatives to a colonoscopy for younger patients. Perhaps the body of doctors that make recommendations on pediatric oncology has guidelines that recommend against colonoscopies for young patients. Etc.

The Bureaucracy we've Got

The father of one of the kids on the soccer team I used to coach is a primary care doc. He has a patient whom he suspects may have colon cancer, and ordered screenings, including a colonoscopy. But the patient is younger than the age threshold for his insurance company to cover a colonoscopy, so they’ve overruled his doc, and won’t pay.

My friend deals wtih this kind of crap all the time. That's part of why he is among the 72% of physicians support AT LEAST a public option.

http://healthcarereform.nejm.org/?p=1790#more-1790