Healthcare Reform: What About Him?

Sitting in a restaurant the other day I couldn't stop looking at a man at the counter. He was perched there on a stool-- a big man, tall and very over weight. He was noisy, poorly groomed, and he was wearing a C.R.O.W. walker. The latter is a custom boot designed to protect a foot that has been severely damaged by diabetes.

He ate an enormous plate of food, none of which appeared consistent with a diabetic diet, and polished it all off with a strawberry shortcake with whipped cream. Now, granted, I'm sitting 15 feet away and my view is not perfect but I can't take my eyes off this guy. His noisy attenion-getting banter with the kitchen staff was enough that you couldn't ignore him in the first place. His reckless eating was really the thing, however, and I just had to keep looking his way to see what else was going in that pie hole.

Problem is the CROW walking boot. Those are utilized in cases of severe injury to the foot-- injury that almost always stems from diabetic neuropathy, or loss of sensation in the foot. The combination of this man's diet, size, hygiene, and the appliance on his foot made me think: What's it like to take care of a person like this? How much does it cost? Who's paying? I'm guessing he was in his mid-50's going on 80 and, again, just guessing based on the visual evidence, probably on disability as is so common in my neck of the woods. So who pays for this guy? "The government" comes the stock answer. Hello "government," thank you for reading this today.

Let's pretend all of my assumptions above are true: If the cost of healthcare and entitlement programs are going through the roof how do we regain control? How do we reduce the expense of taking care of people who really don't give a rat's ass?

The above scenario is not isolated. I see people like him every single day in my office. They come in with back, knee, or hip pain. They're on disability. They smoke. They're diabetic. They show absolutely no sign of making any investment in their own health and well-being but they want to feel better and they want everything done possible to that end. Everything I can do. They're not usually too keen on hearing about what they should do.

I've thought about this quite a bit since leaving that restaurant and have come to this conclusion: Realistically we're not going to be able to do very much about that man and others like him. A few may respond to education and enlist in their health care. But most won't. Most will simply continue to show-up in the emergency room in crisis, show-up at their doctor's offices wringing their hands about how they try. No, the solution is extinction. Realistically there is very little we will accomplish trying to transform a lifetime of low self-esteem and poor habits into a vigorous healthy individual. What we can accomplish is succeeding in assuring this lifestyle disappears.

Healthcare reform will require education reform. A national healthcare plan will have to be developed to include education that begins in daycare; meaningful education. It will discard cartoon figures pitching the advantages of eating vegetables and, instead, sweep schools and daycares clean of all the prepackaged garbage that still gets served up to our children today. Nutrition education must take place by example.  The hardest part will be financial: McDonald's Corp. may slip off the list of best dividend performers.

Likewise, physical education classes have to become about lifetime activities like yoga, stretching, walking, and weight training. Sports are fine as electives. What I'm talking about is learning that every day starts with self-care in the form of exercise. There was a poster a few years back published by the American Academy of Orthopedic Surgeons showing a kid sitting in his room at a computer that featured the tag line: "Sure he can run the latest software, but can he run a mile?"

Not taking care of unhealthy people who do nothing to help themselves is not an option. We're stuck taking care of that guy at the lunch counter until he slurps down his last 16 ounce Mountain Dew. Our obligation is transforming healthcare into a system of care that includes the education needed to make certain that patient type disappears entirely. A system that begins in very early childhood and never lets off the gas. Unfortunately, if we can't find a way to commercially exploit the process it will probably never find the support needed to succeed in the good ol' US of A.