Vaughan Institute of Risk Management and Insurance Henry B. Tippie College of Business
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The University of Iowa

Americans, Take Charge of Your Health

by Scott Fisher, President, McCassen Consulting and Adjunct Professor

Reprinted with permission of the author from the Corridor Business Journal, Feb. 8-14, 2010

Scott Fisher

Healthcare reform efforts have become a three ring circus, complete with elephants and donkeys, and performers breathing fire under the biggest gold domed top of all. P.T. Barnum would be proud. Yet most Americans would say that we are further away from reform today than we have been in the last six months. However, as the theatrical credo says—the show must go on—whether or not a reform bill becomes law.

When you examine several key indicators, it is hard to argue that our healthcare system cannot benefit from change. For example, the United States spends more than 16 percent of its GDP on health care. Most other countries spend less and cover more people. In addition, the quality of care in those other industrialized countries does not suffer. For more complete information, see the Organisation for Economic Cooperation and Development’s “Health at a Glance 2009.”

Many factors influence the costs and quality of health care, and while significant discussion has taken place on many fronts, some key areas have not been effectively addressed to date.

To illustrate this point by focusing on one key area, we need to return to the circus. Imagine yourself in the house of mirrors. As you are pointing your finger at all the things wrong with today’s healthcare system, the finger points back at you. From my perspective, a major factor in future healthcare cost increases is a general lack of personal accountability for our health. Instead of just transferring the majority of cost of healthcare reimbursement to insurers, many of us have tried to transfer the obligation of good health to them as well.

As partial evidence, I point to information from the Office of Public Health and Science that indicates that onethird of children and teens in America are overweight or at risk of being overweight. Sadly, the information also indicated that overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

This followed 2005 information from scientists supported by the National Institute of Aging that stated, “The U.S. could be facing its first sustained drop in life expectancy in the modern era.” This comes at a time when many advances in health care and disease treatment are occurring, and the risk of decline in life expectancy is primarily attributable to related controllable health factors—obesity, unhealthy eating habits and physical inactivity.

It also comes at a time when many notable, highprofile individuals and organizations are promoting healthy habits and lifestyles (The National Football League’s Play 60 and the President’s Council on Physical Fitness and Sports). The Nickelodeon channel suspended programming for three hours on a September Saturday and encouraged kids to go out and play.

The current House and Senate healthcare reform bills include components for wellness, but the efforts fall into the education category. There are positive intentions among a number of groups, but the result is little action from us. It reminds me of the adage, “You can lead a horse to water, but you can’t make him drink.”

How can we encourage or make that horse drink? Our current healthcare system does not provide adequate incentives to change unhealthy behavior. These incentives (or disincentives) can be incorporated into premium rates and/or reimbursements and can align with the current financing of health care in the U.S. Employers pay on average 84 percent of the premium cost for health care coverage according to the Kaiser Family Foundation’s 2009 Annual Employer Health Benefits Survey. If premium costs moderated or stabilized in part due to healthier behaviors, many employers would be happy. After all, healthcare premium increases have outpaced general inflation by more than 4.5 to 1 over the past decade, according to Kaiser Family Foundation research.

Most employers would also recognize the productivity benefits of a healthier employee having fewer sick days annually because of better overall health.

There are many aspects of the healthcare system that can best be addressed by legislation, like coverage availability for uninsured individuals and tort reform. But the personal responsibility for healthy behaviors is just as meaningful a component of healthcare reform, and it must first be addressed at the dinner table, in the parks and gymnasiums and at the workplace, not in the halls of Congress.