Health care costs are an issue we need to address. Those costs must be seen in light of human costs as well as the larger vision we have for ourselves as communities and as a nation.
Some would have us ration health care based on lifestyle choices: Persons who make good choices (exercise, healthy diet, etc.) have access to health care; persons who make poor choices (smoking, drinking, inactive lifestyle, etc.), have less or none.
At first glance, this sounds commendable. I work hard at a job, and I earn the benefits of more pay. I work hard as a parent, and I enjoy the fruits of watching my child grow up into a responsible adult. I take care of my health, and live a long, satisfying life. But life and health are rarely that straightforward. Memories of James Fixx come to mind. Fixx was a fitness author who dropped dead of a heart attack at age 52.
“Reap what you sow” is one phrase that describes rationing health care based on individual lifestyle choices. However, in the context of health care, that phrase serves instead to cheapen human life and reduce the complexities of our lives to single choices taken out of context.
The following situations describe what look like “lifestyle-related diseases or disorders.” However, with more information, a complex view of the whole person comes into focus. It is this complex view that we all need to recognize in order to achieve health as a society. Examples:
- The person who is overweight also has a developmental disability, lives on $720 per month plus food stamps, eats prepackaged foods and never learned to cook.
- The man or woman who smokes likes a chimney also has schizophrenia (problems quitting are common in persons with schizophrenia).
- The woman who struggles for decades with addiction survived on the streets from age 10 onward through the “kindness” of men who used her for sex and kept her compliant with drugs.
- The woman with diabetes, widowed for three years, suffers from depression, finds managing diabetes overwhelming, takes comfort in food and hopes that not managing diabetes may end her life and stop her pain.
From my professional work, I can assure you that we have multitudes of persons within our communities who have stories just as compelling as the ones above.
When we choose to see only the lifestyle choices that contribute to health problems, we sit in judgment upon persons and treat them harshly. We see persons that fit the above descriptions as “other,” as “them” or “those kind of people,” and we all too often treat them as if they are invisible and unwanted objects in our social horizon.
Yet, behind every person with a lifestyle-related disorder or disease is a unique human story that calls upon us to exercise compassion, understanding accountability and creativity that support the person’s need to change.
We are an odd lot, humankind. Change frequently takes place slowly over time. Sometimes we have a “knock me off my horse” experience and transform quickly. More commonly, change is like an onion: We see one layer, peel it off, work it through and then we see the next layer of change we need to address … and so we go along our life’s journey.
There is no quick fix for the situations described above. And change does not happen in a vacuum. Healthy change occurs when an individual experiences insight, empowerment, personal and social support, adequate and appropriate health care, access to resources, spiritual strength … any or all of these in whatever ways unlocks for us a vision that we can be better than we are today, and that we want to be better.
That change, that vision, requires that none of us be disposable, that we see each and every person as part of “us.” We need to recognize that to abandon those who suffer is to violate our own humanity.
“Reap what you sow” as a means-test takes us to 20 years from now sitting around the table talking about which of our friends and family members are dead because they were denied health care – not because the care wasn’t available, but because society chose to treat people as objects and “other,” rather than valued members of our communities.
May “reap what you sow” be replaced by “comprehensive health for all.”
Marian Beaumier is a clinical social worker, former clinical director at St. Joseph Family Center and keynote speaker at Guidelines for Trauma-informed Care workshop.