The Affordable Care Act (ACA) has polarized many people (if you are among the 3% that don’t believe me, check out the responses on my post Cancer v. The Constitution). While I am the first to admit the law isn’t perfect (for example, lack of accountability from insurers and providers regarding charges and cost of care), the legislation does contain many good things (e.g. health insurance for all, no pre-existing conditions, and no co-payment for vaccinations).
I believe than an imperfect law that sets us on the right course (affordable care for all) is better than our current health care system. Let’s not forget that even the constitution wasn’t perfect at birth, hence all those amendments I learned about studying for my citizenship test. The fact that a piece of legislature might need some fine tuning down the road is not a new concept and is surely something we can handle.
As I thought more about the ACA and about accountability from insurers, Big Pharma, and providers, I also thought about personal accountability. I know behavior can’t be legislated, but if you really believe in the concept of universal health care, then you must also believe that we are all stewards of the system and so it behooves each one of us to do our personal best with our health. First of all, we’ll be healthier (that’s the goal of not only the ACA, but really everyone’s goal, is it not?). And secondly, striving for better health as well as being responsible with health care lowers costs for everyone. Think of it as resource conserving, just like turning down the heat while you’re sleeping lowers your energy bill and reduces your carbon footprint.
If you believe in universal health care, I challenge you to make 4 changes this year in your health and/or how you access your health care (the latter obviously if you are lucky enough to have health insurance). The kicker is you have to build on each change, so once you have done one thing, you have to keep it up while working on the next.
If you’re stuck for ideas, here are some suggestions:
1. Walk 150 minutes a week (that’s 30 minutes 5 times a week). It has health benefits that equal a 20 lb weight loss. Start with 10 minutes a day at lunch – you’ll almost be 1/2 way there. If you are already exercising regularly, find a way to do just a little bit more.
2. Eat breakfast (a healthy one, if possible) every day. It doesn’t matter if don’t think you’re hungry (although, you probably are and just don’t know it). Many of my patients complain of fatigue and almost always when I ask what they had for breakfast, the answer is, “Nothing.” Your body has fasted all night and needs energy for that 30 minute walk you have planned! And if you are trying to lose weight, well, studies tell us you will be more successful if you eat breakfast.
3. Eat 25 g of fiber a day. You may think you eat a lot of fiber, but the average American diet has approximately 10 g. Check fiber content on food labels or online and keep a log for several days to keep yourself honest. A high fiber diet is associated with lower rates of obesity and makes you poop regularly. Hey, constipation accounts for 8 million doctor visits a year! In one study, Medi-Cal (California Medicaid) paid more than $18 million over a 15 month time frame for the diagnosis and management of constipation! Fastest way to 25 g a day is a high fiber cereal (remember breakfast!). My favorite breakfast is 1/3 c Bran Buds (13 g of fiber) with Greek yogurt and 2 tbsp. of walnuts.
4. Limit your sexual partners, don’t hook up, and make sure you have safe sex. STDs cost $17 billion a year, yet are essentially preventable. No night of passion is worth gonorrhea, chlamydia, or HIV.
5. Speaking of chlamydia, if you are a woman and 25 years or younger get tested every year for chlamydia. Chlamydia typically has no symptoms, but it can spread to the fallopian tubes causing a serious pelvic infection. Annual screening (and treatment if positive) in this age group dramatically reduces the risk of this pelvic infection. If you don’t have health insurance you should be able to get tested for free at your county health department, but college health departments and Planned Parenthood are also lower cost options.
6. If you smoke, quit now. Really, call 1-800-quit-now. Right now. Smoking causes asthma, emphysema, cancer, premature delivery, and if your baby is exposed to second hand smoke he is more likely to develop asthma or die from SIDS (sudden infant death syndrome).
6. If you are overweight or obese try journaling. Studies tell us people eat about 1,000 calories more a day than they think. Weighing and measuring portions and writing everything down is a cornerstone of weight loss. Try and lose 5-7% of your body weight, you will reduce your risk of getting diabetes and you will feel better.
7. If you don’t want to get pregnant (or get someone pregnant) use contraception. Yes, it should be covered by every health plan, but make every effort to get it and use it. Correctly. This requires heterosexual couples discussing if they do or do not want a baby. The IUD has lowest failure rate and if I wrote the ACA would be available with no co-payment for the IUD or for insertion. If you are using birth control pills, keep in mind that in one study of birth control pill takers with an average age of 22 many women missed pills. The average number of missed pills/month was four.
8. If you are pregnant, make every effort to breastfeed. Breastfed babies have a much lower risk of many health problems (and breast milk is free!). By one estimate, if 90% of babies were exclusively breastfed for 6 months $13 billion in health care costs could be saved.
9. If your doctor gives you a prescription, be honest with yourself and your doctor about whether you will really take it. A lot of money is wasted on prescriptions that are filled but only a few pills out of a 30-day supply are used (never mind increasing medical waste). If you have second thoughts about the medication you are prescribed, talk with your doctor.
10. If you think you need medical care on the weekend or at night and it’s not an emergency, call/check to see if there is an urgent care clinic. Emergency rooms are filled with patients who have diaper rashes, minor injuries, or colds. The problem? It is far more expensive to treat these things in an emergency room than in a clinic. If you have chest pain or are short of breath you need an ER, but if you’re not sure if you really need emergent care, think about calling and asking.
11. Give up trans fats. These are modified fats found in many prepackaged foods and used in many restaurants (except in New York and California, where they are banned from restaurants). Trans fats (the label will say “partially hydrogenated oil”) cause heart disease. Big offenders are frosting in a can, cake mixes, and coffee creamer. People talk about banning sugar, but you can consume sweets responsibly. There is really no safe lower limit for trans fats.
12. If your doctor recommends a test, ask how it will change your care. Many tests are just not needed, and some carry significant risks (for example, the radiation from a single CT scan of the abdomen and pelvis has a 1/1,000 risk of causing cancer). If your doctor gives a lame-ass answer like, “I’m just looking,” get another doctor. Medicine isn’t a fishing expedition. Every test should specifically rule in or out a specific condition.
13. Don’t ever use a tanning bed. Ever. Using a tanning bed before the age of 30 increases your risk of melanoma (the most deadly skin cancer) by 75%. Melanoma kills more than 8,000 Americans a year. Tanning beds also increase your risk of other skin cancers (squamous call and basal cell cancers). The World Health Organization (WHO) has tanning beds on the same list as plutonium with regards to cancer risk!
14. To further reduce your risk of skin cancer use a sunscreen with an SPF of 30 or more for extended outdoor physical activity (use at least an SPF 15 for every day). Wear UV-blocking sun glasses to protect your eyes and a hat to provide extra protection for your face and eyes.
Need more suggestions or have your own? Ask/leave them in the comments.
Accountable care should be an idea that we can all embrace.