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Ask not what the ACA can do for you – ask what you can do for health care system in America?

By Dr. Mona Mangat
. 1 Comment(s)

‘And so, my fellow Americans: ask not what your country can do for you - ask what you can do for your country.’ President John F Kennedy spoke those words at his 1961 inaugural address. Back then, it was a reference to being an alert and involved citizen. But this was not the first time that Americans have been asked to sacrifice in the name of country. During WWI, many Americans rationed their food so they could send portions overseas and many women replaced their husbands at their place of work so their husbands could fight overseas. So, why today, is asking the average American to sacrifice- in the name of the health of our country- anathema to the American Way? It’s seen as an unacceptable request and an infringement upon our rights and civil liberties.

Here are some interesting facts:

-       On average, about 20% of the population smokes

-       63% of Americans are overweight or obese

-       58% of motorcycle riders do not wear helmets

-       5% of Americans report vigorous physical activity on any given day

A recent study released by the American Lung Association finds that smoking costs the state of NY $20 billion/year when medical expenses, lost worker productivity and premature death are taken into account. A 2009 CDC report finds the direct and indirect cost of obesity to be as high as $147 billion/year. Some limited data from U-M Physical Medicine and Rehabilitation Department finds the average cost of care for unhelmeted riders ran $43,053, compared with $23,201 for helmeted riders. HHS released a report several years ago that quantified the cost associated with being overweight and a sedentary lifestyle was $117 billion annually. Adding up these numbers roughly gives us close to $300 billion annually that can be attributed to our personal choices. Let’s compare that to $940 billion/over 10 years - the cost of the PPACA that was passed this past March.

So, how can we avoid some personal responsibility for a health care system in crisis?  It’s true that our current system of employer based, for-profit insurance has led to a crisis in access to care for millions of Americans. The advent of costly new drugs, medical devices, and diagnostic tests has contributed to the rise in health care spending. And the litigious society we live in has led the practice of medicine to become defensive with redundancy in testing and evaluation. But to disregard our own personal part of this story is an amazing form of denial.

As a physician, I am aware of the large role that both genetics and socio-economic status plays in the lifestyle choices we make. But I am convinced that we have created a culture of wealth and prosperity in which excess is a sign of success. We value the adage – ‘more is better’. We seem to believe the bigger the portion size, the better; the larger the vehicle, the better it is. And historically being overweight has been closely associated with personal wealth and accomplishment. This belief even extends to our thoughts about health care – the more tests and treatments we receive the better we are. The data does not support this statement. In fact, we don’t get better health care outcomes despite the incredible amount of money we spend- there seems to be a level of plateau that has been reached in the US.

In crafting the ACA, there was a realization that helping Americans remain healthy should be a primary goal. In line with that, the ACA will appropriate $5 billion for fiscal years 2010 through 2014, and $2 billion for each subsequent fiscal year, to support prevention and public health programs.  A National Prevention, Health Promotion and Public Health Council has been established to develop a coordinated strategy. Starting in 2011, grants will be provided for up to five years to small employers that establish wellness programs.

This focus on wellness is commendable, but making recommendations is not enough. So, what I’m proposing is not some crazy plot to slowly eat away at the fabric of American freedom. I want every person to think about what we are costing the ‘system’ each time we pick the Venti over the Tall size or we decide to Super-Size our lunch. Think twice next time you decide to skip the gym and watch Survivor or you choose to light up that cigarette. Then stop to consider the social cost of these actions or inactions. As a colleague so eloquently stated ‘the real value of prevention comes from the ability to extend overall life years and simultaneously compress the years of sick life.  What you get out of this is the opportunity for more productivity…..  But those extra years of healthy life have value in themselves.’

I’ve got to get down off my soapbox now and head to the gym.

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  1. Lucas Restrepo


    I'll toast to that!

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