You are raising an intensely important question with respect to National Health Coverage

[Mike 03]

If we, as a nation, are going to provide health coverage to ourselves (from ourselves), paying for it, as a nation, through our government, does our government have a right to tell us how to live?

This is not miracle money: We are paying money to each other to get eachother well.

Or, maybe, we need to make these choices as well, since we are the payors.

I think that's a good question.

Can they tell us:

Don't smoke.
Don't drink to excess.
Don't eat processed carbs.
Limit your simple sugars.
Limit certain complex carbs such as corn, wheat and potato.
Exercise aerobically at least (at least!) ninety minutes a week.
Exercise anaerobically at least ninety minutes a week.
Try to sleep at least seven hours a night.


Some really bright person here on DU mentioned an "Opt Out" option when it comes to particular mandatory practices, and I think this is brilliant.

Anyone who does not wish to comply with the suggestions to become more healthy can simply opt out of the health care program and get whatever kind of health care they wish to get!

Nobody should be "made" to do anything contigent upon anything. And anyone who is not interested in lowering their risk for costly chronic disease should be able to shop anywhere else they desire to get health care.

[Horse with no Name]

1. Do they do that in any of the other industrialized countries?

I think that is what we need to look at.

[ecstatic]

4. Do other industrialized countries have high obesity

rates/smoking rates/etc?

[Horse with no Name]

10. It isn't JUST about obesity

What about risk-takers? You know trauma costs are very high to hospitals. Are we going to make ANY high-risk lifestyle, whether it is by smoking, drinking, gluttony, drugs, unsafe sex practices, athletes, etc...opt out too?
How about just offering nutrition counseling, make it easier for people to get fresh fruits and take the fucking HFCS out of everything, smoking cessation programs, etc.
Why make it punitive?

[timeforpeace]

2. What if you don't want to comply and don't want to opt out?

[ecstatic]

3. good idea but that would still leave millions uninsured:

People who don't want to live healthy lifestyles, yet don't want to pay more for private care.

[sentelle]

5. Interesting question

But to answer your question with a question: does the UK's NHS require it?

Methinks no. Doctors are incentivised to convince their patients to lead healthier lives (which means lower bills, longer lives and less people at the doctors office), but financial incentives on their ability to promite wellness.

And thats what we need here.

[Uzybone]

6. Of course they can

there are many sensible things the government should and is saying to its citizens about their health. Making citizens do something is a different issue. They cannot make someone sleep 7 hours a night. They can ban tobacco or severely limit its use via taxation. They ban "recreational" drugs. Government (i.e the people) have been telling us how to behave since the dawn of time.

[Cerridwen]

7. Abortion? Contraceptives? Treatment for STDs?

Treatment for HIV/AIDs?

How far down that slippery slope you wanna slide?

[nadinbrzezinski]

8. This is done in other countries but not exactly this way

watch sicko for a good example of this in NHS.

The physician gets a bonus every year depending on how many of his patients got better. This means that he had to work with his patients to educate them and encourage them to loose a couple stones, and bring cholesterol under control.

In mexico, not a first world country, nor a national health care system that works very well, does encourage every patient with belly obesity over a certain level to loose weight during the yearly checkup

This is how you implement this. And you also have wellness programs where people can go get the tools to do it.

But yes, we as a nation have a right to do that, and an obligation. Because if we don't the cost will go up due to certain conditions that get very expensive to treat Mexico did not do early intervention when obesity started to become an issue... diabetes rates down there make ours look like nothing.

[Horse with no Name]

12. ding ding ding

This is the right answer.

[mainer]

9. They can charge us more for our health coverage taxes

if we practice an unhealthy lifestyle -- the way insurance companies do. Say, a penalty increase for every pack of cigarettes you smoke, or every ticket you get for not wearing your seatbelt or every OUI. I, for one, don't much like paying high insurance rates to cover people who smoke, overeat, and don't wear their seatbelts.

[uberblonde]

11. In other countries, doctors are paid more to keep you healthy.

The more people they get to stop smoking, or lose weight, the bigger the bonus.

Not this perverse system we have here!

[mainer]

13. Doctors can't force patients to stop smoking

Do you know how many times my colleagues and I have told patients they had to stop smoking or die? Do you think many of them listen? I've seen patients smoking through their tracheotomy tubes after they've had laryngectomies, because they just can't give up tobacco.

People have to start taking responsibility for their own health and not blame everything on the medical establishment. Everyone KNOWS smoking is bad for them. Yet they do it anyway. Whose fault is that?

[nadinbrzezinski]

14. Who is responsible for that? The truth? Not the doctors, and not the patients

the tobacco industry

We know that for all intents and purposes they are selling crack tobacco which is highly addictive.

IN fact more addictive than the non-processed kind

Part of my solution would be to go back to the formulas produced before 1945, which were CLOSER to just rolled tobacco. They were far less addictive and I am almost willing to bet people would be able to quit more easily. I said more easily, not just quit.


As a doctor you may have noticed this, but cigar smokers have a lot less trouble kicking the habit. That tobacco leaf is not processed.

[mainer]

16. Cigar smokers tend to smoke far fewer per day than cigarettes

So another thing that makes them lower risk than other nicotine addicts.

I'm not discounting the difficulties of quitting -- being a nonsmoker all my life, I can't own up to any personal experience, but I do know how hard it was for my mom to quit. Only after two strokes and symptoms of claudication did she finally kick the habit. And yes, tobacco companies bear blame for getting people hooked.

But responsibility for your own health really does start -- and end -- with you.

[nadinbrzezinski]

17. Absolutely, it does start and end with the patient

but I just brought up the addiction of the current formulas. Even my father, a life time smoker, will tell you that cigarettes had more kick after 1950 or so. So if we forced them to use the older formulas MIGHT make the physical addiction easier to break. The psychological that is another story.

Me dad comes home to visit, smoke outside, unless we want to go to the ER due to an asthma attack. He finally got it after I ended up taking steroids.

[cabluedem]

15. I quit 29 years ago. It was hell on earth to quit, thats why most cant do it. nt

[ejpoeta]

19. my mom smoked until the day she died. the doctors would tell her she need to quit,

but she wouldn't. this was a LONG time ago. she died in 1986, and frankly i doubt if quitting would have helped her any. Now, my dad's girlfriend has emphysema and cancer and it doesn't look like anything is going to save her now. Just saw her the other day and she took her oxygen off and went outside to have a cigarette. she is going to die... and stopping now won't help her. she is going to die no matter what she does.

[Cleita]

18. All those things that you list are pushed by the insurance companies and

HMOs too. The fact is that people can do all of the above and still get a debilitating disease, yet I have known people who lived to be ninety who drank and smoked all their lives. Since I get Medicare and I was a smoker and have asthma, I have never been denied health care for my asthma because I was once a smoker, yet I was once denied corporate health insurance because of that particular pre-existing condition. So I think those concerns are premature.

[ejpoeta]

21. but it's easy to make that argument. people are to blame for all the problems

we have with regard to insurance costs. we are all just gluttons who smoke and drink. well, I hate to say it, but who is going to be the one deciding what is and isn't good for you. That sure is a slippery slope. People don't want to be unhealthy, but there are a lot of things here besides just people are lazy and selfish and just gluttons. But it's easier to just say this is all our fault for getting ourselves into this... whatever it is.

[bluethruandthru]

20. If this country is ever fortunate enough to enact a National Health Care Program

i.e., Single Payer, we can't start to nitpick "unhealthy practices". No one lives a totally healthy lifestyle..and things that we think are good for us today...may not be tomorrow (think "food pyramid"). Everyone has something that we could point a finger at..from overeating to not flossing...but the national mindset for single payer has to be that we're all in it together. That we all share the risk and rewards. Once we start down the path of accusing our fellow citizens of driving up the price of things..then the wingnuts will start with their "why should you pay for someone's lung cancer treatment? He chooses to smoke? Why should you pay for someone's brain cancer? They choose to keep a cell phone glued to their ear all day and that caused it! etc. etc.
This is the way the righty talkers have turned us against each other for years and we shouldn't start doing it too.

[RandomThoughts]

22. The real problem is method of enforcement.

If all of society decided that some activity or action should be part of social contract for the good of society, then it should apply to all of society.

The current societal behavior modifications are based on adding taxes to items like alcohol and cigarettes.

If that is the method, it is saying the poor can't do it, but the rich can, unequal justice so it is wrong.

If cigarettes are bad for society, make them illegal, don't just tax them.


There can not be a day where the only people that can order a stake and potato with a glass of wine are the rich, while the poor eat gruel.


Personally I think some freedoms, even if they risk some cost to society should be allowed, if everything is based on money. You will work in a padded chair and never be able to do anything, unless you have money.