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This is a tense time for a lot of early retirees and aspiring early retirees, as we wait anxiously for things to shake out in the current rounds of health care reform. We’ve just learned that the Senate won’t vote on their version of the AHCA, but beyond that, it’s unclear whether this or any bill will move forward, whether we’ll have an intact ACA, or whether we’ll have a technically intact but not funded ACA that turns into de facto health care chaos. Super fun. Health care abyss in effect all the way.
As many of us sit on the sidelines holding our breath, waiting to find out if our health care costs will double, triple or worse, others have aired some version of this sentiment:
It doesn’t matter what health insurance costs because I eat healthily and exercise. So my health will be just fine. Health is mostly dictated by choices.
As though health is something you can totally optimize just by checking the right boxes. (Excuse me while I laugh out loud, and also cry and whimper a little bit.)
That sentiment is destructive because:
1.) It’s not true. You can eat right and exercise and do everything right and still have major health challenges. (See below.)
2.) It suggests that people who face health challenges are to blame for them, which is untrue in many cases, or at the very least, it’s more complicated by social and structural barriers to making healthy choices.
3.) It totally ignores economic principles and is just generally bonkers. Even if you think that the only people who get sick are those who are at fault due to bad personal choices, practicality tells us that it’s not okay for us all collectively to absorb the costs of unpaid medical bills and bankruptcies, and the labor market costs of lost productivity from illness. If you want your stocks to continue gaining value, that requires ever-increasing productivity, and poor collective health is the enemy of productivity. And one of the biggest factors in poor health? Limited access to health care, especially preventive care.
But let’s ignore economics right now, and just talk about the basics of health, namely whether health can be controlled like variables on a spreadsheet. (Spoiler: It can’t.)
Have We Met?
Indulge me in a little storytelling, beginning with some (re)introductions.
Hi, I’m Ms. ONL* (*not my actual human name), a long-time healthy eater who’s always been active way beyond the recommended guidelines. I’m also an ideal weight according to the charts, have excellent scores on all the blood tests (gold stars!) and take extra steps to be healthy like sticking to mostly organic produce, avoiding cooking in plastic, eliminating endocrine disrupters and antibacterial agents from the house, etc. I rarely drink and have never smoked tobacco. You know, your average health nut. My only real health sin is not sleeping enough these last few years of work. Here’s something else about me:
I’ve always been sick. I was born prematurely and racked up major health care bills in the NICU, which was the least of my parents’ concerns given that I almost didn’t make it. When I was eight, I got a serious bacterial infection that required a two-week hospital stay and drug doses more in the range of “elephant” than “little kid.” In high school, what should have been a standard case of strep turned into scarlet fever because my immune system is kind of a slacker, in case that wasn’t already obvious, and there are a handful of other times when some minor thing turned more serious for me. In my 20s, I found out that I have a small brain tumor I’ll always need to keep an eye on. In my 30s, I got diagnosed with an autoimmune disease that I’ve probably had for 20+ years, that increases my lifetime odds of intestinal lymphoma fairly dramatically, as well as my odds of getting other autoimmune diseases along the way. And there’s plenty I’m leaving out.
I’m thankful every day that I don’t actually feel sick, at least not anymore. But I know that I’m one big walking pre-existing condition despite only ever having lived a super healthy lifestyle (okay, freshman year of college notwithstanding). And if my past is any indication, chances are good that expensive care lies ahead for me.
Now meet Mr. ONL* (*not his real name either). A guy who’s always radiated health. A lifelong athlete with years of competitive sports and four marathons under his belt. Not always the absolute healthiest eater, but nothing terrible. A little smoking in his younger days, but not for a long time now. No heavy drinking. (Again, we’ll give him a pass for college.) Still super active, despite being an old man of 40 (kidding! not about the 40 part, just the old part).
And guess what? He’s sick, too. Apparently because we like to be well-matched in all things, he also recently got diagnosed with an autoimmune disease that increases his intestinal cancer odds. #soulmates (#intestinemates?) Now he’s on drugs that come with a gag-inducing price tag attached, and will require regular and costly screenings for the rest of his lifetime. Yippee!
I doubt many people who meet us think of us as sick (“But you climb mountains!”), but that’s our story. In our small sample size of two, we have two examples of how you can do everything right, or at least mostly right, and still be sick. And that’s not even going into our lifetime odds of being in a car accident or having another serious injury.
I could understand why someone might argue that our health histories dictate that we should keep working, to ensure that we always have employer-provided health care (reminder: the U.S. is one of only two major industrialized nations who use this system, by the way). But the flip-side is: we don’t know how many fully able-bodied years we have in front of us. Our health is exactly why we’re in such a hurry to retire in the first place. We’d rather risk financial ruin than risk spending all our good years working.
Health Isn’t Something We Can Entirely Control
I’m just about as health nutty as they come, so believe that I’m all about reducing our risk factors and increasing our odds of living long, healthy, able-bodied lives. I believe 100 percent that the choices we make impact our health. Though I also believe that not everyone is in an equal position to make healthy choices, and there’s much in our social and built environments that contributes to poor health beyond people’s control. Which isn’t even touching the whole spectrum of mental health, or of physical disability.
But as our stories show, no amount of optimizing can control for every variable. We all know people like us, who make the right choices and still end up with health challenges, or even who end up dying tragically and unexpectedly at a young age. We feel like our challenges are super minor in the scheme of things, and only disrupt our lives in minimal ways, which we’re grateful for. But they’re still expensive, and that matters when we’re talking about the cost of care over the long term.
Why It Matters
We as a society need to have a very different conversation about health than the one that’s happening now. What we’re all calling health care reform is really health insurance reform. It’s not really addressing how we deliver and price care, or how we help people get healthier well before they ever step into a health care setting.
It’s no secret that we’re over-testing and in some cases over-treating patients, and we all bear the cost of that. We compensate providers based on how many procedures they perform, not how they benefit patients, which creates all the wrong economic incentives. The U.S. foots the bill for pharmaceutical research for the world, and lines the pockets of big pharma with the exorbitant drug prices we pay (and can’t negotiate, by law). We also have far too many food deserts where it’s nearly impossible to find healthy, affordable food, and we have huge percentages of the country where there aren’t enough parks, trails and bike lanes to let people exercise outside safely. And we continue to cut back physical education classes and allow the soda companies to sell their products to kids in schools. All the while, agribusiness giants are developing ever-more-insidious ways to market addictive and borderline-toxic foods to us in ever-increasing quantities.
We have too many vicious cycles operating simultaneously to count them all, and if we want to have meaningful improvements in our health and our collective costs, we have to begin to unravel these things.
But we can’t have that conversation if we’re pointing the finger, blaming people for risk factors or illness that may not even be their fault, and acting as though health is something it’s not, something entirely within our individual control.
I’d love nothing more than for that to be true, to have total control of my health, but as I’m reminded every day, it just ain’t so.
The Health Discussion
Thanks for indulging my rant here. Now it’s your turn. Where’s your head in all of this? Witness anything that has assured you that there’s tons about our health we don’t understand and can’t control, like Penny’s recent visit to the neurologist where she saw a little kid there as a patient? (And anyone else suspect as I do that there’s some secret fat shaming and poor shaming behind a lot of this talk about controlling our health?) Or want to vigorously disagree? Bring it!
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Categories: we've learned