Cash-for-clunkers was extremely successful by any measure. Even those who can’t fathom government doing anything right were soon silenced by the program’s popularity. But the overwhelmingly positive outcome should be of no surprise. Give people the right incentives and they will modify their behavior accordingly. In this case, newer, more efficient and less polluting cars were made affordable through government-sponsored subsidies and they sold like hot cakes. The other government initiative of this year, the infinitely larger and by far more controversial Health Care Reform Bill, could learn a thing or two from “cash-for-clunkers.”
In the unlikely event that some readers are not completely up to date on the most recently debated version of the bill, please allow me to reiterate a brief summary of the main issues as they stand at the moment.
As you probably heard, the Senate Finance Committee is getting ready to vote on its own version this coming week. Although, we all just lived through a tsunami of controversy over health care, it seems that only two major issues have kept the legislation from going forward: coverage and costs.
The goal of universal health care coverage in America is nothing new, of course. After all, we are an anomaly among industrialized nations in our inability (or unwillingness) to provide access to health insurance for all our citizens. The reform bill, as it stands right now, would probably still not achieve that goal, however, most of the currently uninsured would be required by law to purchase insurance or face financial penalties. In return, insurance companies would no longer be allowed to deny coverage to applicants, e.g. on the basis of “pre-existing conditions.” Those who still could not afford the mandatory insurance coverage would be eligible for government assistance through tax incentives and other subsidies as well as additional expansions of certain Medicaid programs. There is still much debate over the potential costs of these subsidies and the best ways to pay for them, especially since President Obama has repeatedly vowed that health care reform must be “deficit neutral” – in other words, pay for itself.
As a matter of disclosure, I want to identify myself as a strong supporter of a “single payer” universal health care system as it exists in different varieties in Europe and Canada. As a second-best choice, I would like to see the so-called “public option” included in the final bill as a viable alternative to private insurance plans.
Having said that, I am also a strong believer in individual responsibility as an essential part of public health policies. But our current system is too single-mindedly focused on the treatment of illnesses and not enough on pro-active preventive health care. In other words, we are better at making sick people healthy than keeping healthy people from getting sick.
The health care system itself, in its current form, is not designed to change that. Insurance companies pay physicians and hospitals readily for ever more expensive procedures and services, but next to nothing for preventive measures, such as nutrition- and lifestyle counseling. For instance, if you see a doctor because you have difficulty breathing, he or she will be reimbursed for having your lungs x-rayed but doesn’t get a dime for explaining the dangers of smoking. Likewise, it is relatively easy to get coverage for leg amputations in cases of severe diabetes or bariatric surgery to treat morbid obesity, but not for instructions on dieting and weight loss – and this despite the well-known fact that treating preventable lifestyle-related diseases form the heaviest financial burden on health care.
Rethinking the priorities in our health care delivery system is a matter of urgency. The aging of large parts of our population combined with an epidemic growth of obesity, diabetes, hypertension and cancer are already pushing the system precariously close to the breaking point and will render it unsustainable in the foreseeable future.
Coming back to the “cash-for-clunkers” approach, it is easy to see how large scale behavior modification can be directed by providing the right incentives. This, of course, can be a tricky undertaking, as the most recent controversy over the so-called “soda tax” has demonstrated. Nobody wants to feel manipulated, and Americans in particular pride themselves in their independence and self-determination. The “clunkers” program was at least in part so successful because it did not pressure people (to buy new cars) but offered options they could take advantage of, if they chose to do so at their own volition.
All parties to the Health Care Reform Bill could learn a valuable lesson from this event. Health care costs will go nowhere but up if we don’t succeed at improving public health. Universal coverage and affordable access to medical services can only be part of the equation. Serious investments in pro-active, preventive health care programs are imperative. Educating the public about health and health-promoting lifestyle choices must be at the core of these efforts. Employers should be encouraged (e.g. through tax credits) to enroll their employees in gym memberships or sponsor regular nutrition-, health- and fitness seminars and the like. Schools at every level should be required to include health education in their curriculum – and, of course, PE must be brought back and made an indispensable priority.
Nobody should expect that significant progress on a large scale will happen over night, nor will we become a health-conscious nation anytime soon. Just consider how long it took to alter the public’s view on tobacco. Promoting lifestyle changes requires time and patience. It may even take as long as one or two generations. But eventually these changes will have to happen. The question for us today is what we are able and willing to do to at least move the process in the right direction.
Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”
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