don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

From a wellness point of view, the keys to system reform seem to be two in nature:

1. How can reforms motivate people to stay well in the first place with self-managing, healthy lifestyles?
2. What policies might persuade citizens to accept the fact that, at some point in time, medical treatments other than for pain relief are unwise, and death with a bit of dignity is a better way "to go?"

I realize that members of Congress, health care industry leaders and high officials in the Bush Administration do not, as yet, rely on daily “Don’s Reports” for primary guidance in shaping national health policy. Therefore, expecting that this essay will bring about early reform is a bit like sponsoring a rain dance to end the drought here in Florida -- but what the heck, hope springs eternal and all that. Who knows -- maybe the president will read this. At least you’re reading it, and that’s a start! Besides, there's always a chance a good idea or two will make a difference and, after all, taking chances is the American way. Last year, we spent one billion dollars on games of chance, and that's not even counting weddings.

Many experts believe that the major culprit in the seemingly endless rise in health care costs can be traced to the fact that the patient has been removed as a major participant in the financial and medical choices that are made by others in his name. To reintroduce the patient or, better yet, the empowered consumer as the major participant in health care choices, I believe that America needs a two-tiered medical system. One tier should be for those who want to treat their bodies like a temple or a work of art; the other for those who see their bodies as porta-potties. Data from the Health Care Financing Administration reflect how today's health insurance is based on the temple/work of art-types subsidizing the outhouse-types. If you are a temple/work of art-type, you might want to go to the nearest window, open it wide and shout: I'm sick and tired of this bullbleep and I'm not going to put up with it anymore!" Of course, not everybody has seen or remembered the movie “Network,” so feel free to make up your own lines to express frustration with the system. Ready? Go.

Data from the State of Washington a few years ago illustrate the problem I’m describing. In one case of an insured group with 125,000 members, sixty percent of clients accounted for only eight percent of the medical bills, whereas five percent of the clients ran up sixty percent of the costs. The latter group was overwhelmingly composed of lifestyle kamikazes hell bent on making life miserable in a health sense for themselves and those associated with them as members of the health plan collective.

As one columnist for a local paper noted, smokers have at least a thirty percent higher chance of heart disease (actually, it is much higher than that.) At just one hospital in Spokane, surgeons did 1,398 heart surgeries in 1992 -- at $30 thousand a pop. Even if only thirty percent were occasioned by smoking, the elimination of this risk factor at this one hospital for the group plan would have saved 12.5 million dollars.

This plan would require no draconian cost cutting, security, improved access or new payment methods. All that would be required would be wellness programs available to all, as a choice, with a two-option system depending upon citizen lifestyle preferences. Nobody would be coerced, cajoled, or whatever to take better care of him/herself or to stop ruining his/her own life with deadly behaviors. The rest of us, however, would be relieved from having to subsidize these choices.

Hundreds of examples could be given for dramatic savings from lifestyle reform. Stop one low-birth-weight baby situation (smoking and alcohol usage increase the risk 100 percent) and the saving would be about $160,000 per incident!

While vast savings would come from discouraging self-destruction, the real gains would derive from promoting wellness! Imagine the savings from getting people to actually do positive things, like exercise! Then fantasize the other possibilities, such as the following:

• learn and practice stress management,
• eat wisely,
• have positive fun,
• increase personal efficacy in varied situations via better relationship skills,
• have more peak experiences,
• derive more enjoyment from family life,
• develop more passions and leisure interests,
• obtain work that is more interesting and satisfying, and
• find reasons for living that give exceptional purpose and meaning to existence.

Tell your Congressmen and women and anyone who will listen to you in Washington and elsewhere that they should spend more time on ways to make the population healthier (with wellness incentives) and less time arguing about patient bills of rights, drug plans, HMO reform and all the other details -- it’s lifestyles that really make the difference in life quality.

Meanwhile, find out more about how you can associate with a health insurance program that rewards you for being a high life, not a low life. Years ago, there was a company called “Dominion Resources” in Richmond, VA. that offered to pay people for staying well and helped them to do it with a wellness program and cash incentives for getting serious about self-responsibility and personal excellence. There was a story about it in USA Today (5/14/93, p. B-1.) I don’t know if they’re still in business -- I hope so.

Do one more thing. Don’t wait for Congress, the president, HMOs or others to reform the health care system: Focus instead on your own lifestyle. Live in such a way that you dramatically reduce your chances of needing a medical system or subsidizing those who do (unnecessarily purchasing expensive drugs, services, etc.) because of reckless endangerment of their health and your pocketbook. Of course, keep looking on the bright side of life.

(Note: This essay will be filed in the archives in the MENTAL DOMAIN under the skill area of effective decisions. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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