Get real about health care

As a percentage of gross domestic product, the U.S. spends more on health care than any other country, and one of the main objectives of health care reform is lowering costs.

Right now, however, health care costs are being lowered on the backs of physicians and other care providers. Here in Buncombe County, Project Access pairs people in need with specialty physicians who donate care. Mission Hospitals gives away millions of dollars’ worth of discounted and free care each year, as do local physicians and other providers. That's great for the patients and their families, but it doesn't solve the larger problem.

Meanwhile, Project Access is overburdened, as more and more people lose their jobs and their health insurance. Expecting physicians and hospitals to offer free care is not a sustainable solution to rising costs.

At the same time, we’re told we can lower costs by staying well: "Wellness" is cited as a goal in nearly every health care conversation. Eat right, get exercise, don't use tobacco or too much alcohol, get plenty of rest and everyone will be fine, right?

Not really.

Putting the onus on the person is just blaming the victim. No matter how well we take care of ourselves, some of us will get sick, from environmental toxins or perhaps a genetic predisposition to a specific illness. Even a fitness saint can't avoid something that's genetic.

Getting sick is not an indication of a lack of moral character.

Much of the most expensive care wouldn't be necessary if chronic illnesses were managed early on instead of waiting for a crisis to occur.

Managing blood-glucose levels in someone with diabetes is far more cost-effective than waiting for them to have a stroke, go blind, go into renal failure or require an amputation. And though the supplies may be too expensive for people who lack health insurance, they’re much, much cheaper than the cost of treating some of these complications.

The real problem is that crisis care is more profitable than managing chronic illnesses. If you doubt this, consider the results of the Asheville Project, which gives city employees incentives and the means to manage five illnesses: depression, diabetes, high blood pressure, high cholesterol and asthma.

The project pays pharmacists to help people manage these illnesses, and since it was instituted, the city's costs have dropped dramatically. But dialysis is much more profitable, and as long as the incentive is there, you can't really blame the medical-industrial complex for cashing in.

People who don't have insurance are far more likely to die of cancer — after long, painful and expensive treatment — because they're typically not diagnosed early on. By the time you feel a lump in your breast or have digestive problems, your cancer may well be too advanced to cure.

And while improved technology can keep people alive longer, it’s hideously expensive and will probably postpone the inevitable by only a few days or weeks.

A policy that might have saved billions of dollars — allowing Medicaid patients a paid consultation with their physicians about end-of-life care — was instituted Jan. 1 and rescinded days later after some people revived the specter of "death panels." Rather than wage a truth campaign, the federal government deep-sixed the policy. As a result, more people will receive extremely costly, life-prolonging care because they didn't specify otherwise.

Conversations about end-of-life care should be a part of any wellness policy. Everyone should have a living will and appoint a health care proxy who will follow their wishes before they get sick (you can find everything you need at fivewishes.org).

Mental illness is probably the most dramatic illustration of what can happen when disease management is lacking. Simple depression becomes severe depression and the person can't function, loses his or her job and often winds up on the street. Timely care will often slow or halt the progress of even more serious forms of psychiatric illness.

According to a 2006 study by the Bureau of Justice Statistics, 64 percent of local jail inmates, 56 percent of state prisoners and 45 percent of federal prisoners show symptoms of serious mental illness. Walk through the Buncombe County Jail and you'll see such conditions firsthand.

This reality is inappropriate and inhumane, not to mention expensive, but states' mental health budgets have been slashed, and there are few other places for people to turn. In these hard economic times, caring for people with mental illness is just not a priority for government.

It's time to define "wellness" as something beyond exercise and diet. Real wellness is also about making sure that people have access to primary care — and, if they do get sick, that they can get the care they need before serious complications develop.

— Former newspaper reporter Leslie Boyd is president of Life o' Mike, a nonprofit health care advocacy-and-education agency. She can be reached at lifeomike@gmail.com.