Saturday, July 11, 2015

Are health care and medical care the same? (Part 2)

[Continued from Part 1]

Your health care is mainly the sum of your own behaviors that bear on your own health.  And unlike a medical professional’s services, health care - your own behavior - is free.  You don’t get a bill for quitting smoking; for avoiding junk food; for getting plenty of exercise and so forth.  Your behavior is free. 

This is poorly understood and yet people really need to know because it affects their own health.  It would help if our political leaders addressed this need.  Sadly they are too busy playing the politics.  So long as health care and medical care are widely considered to be the same, I think America will overlook significant opportunities to improve public health and at the same time control our overall medical costs.

In addition to being free, healthy personal behaviors can help reduce the incidence and severity of many types of diseases – e.g., overweight can lead to muscular and joint problems, respiratory problems, even diabetes.  A lesser impact from these ailments would benefit individuals, and would also help control overall medical costs.  In other words, the insight that health care is not the same as medical care leads to increased appreciation of the fundamental importance of public health. 

I think it will also lead to more serious consideration of demand-management strategies for the cost of medical care.   

For the past 50 years, we’ve been trying without much success to manage the cost of medical care by managing supply - limiting benefits, limiting provider reimbursements, even limiting the number of med school grads.  Those supply-management strategies have not worked in the past, and Obamacare evidence suggests they aren’t working now, either. 

I don't suggest we dismantle reasonable strategies for managing medical cost by managing supply.  I do suggest America also needs an explicit and coordinated strategy to manage demand for medical care.   That's because we have a near-critical need for improved public health starting at a personal level.  In other words, we need health care, not just medical care.  And the crucial insight that leads us to this conclusion, is that health care and medical care are not the same. 

“All there is to thinking is seeing something noticeable which makes you see something you weren't noticing which makes you see something that isn't even visible.”
Norman Maclean, A River Runs Through It and Other Stories
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