Brian Toomey is a resident of Dancing Rabbit, the founder of search engine optimization firm JB Web Analytics, and my partner at sustainablog. On the surface, this may see off-topic, but, as you’ll see, Brian makes a clear connection between the health care debate and environmental issues.
- It may reinforce our cultural denial of death: Ray Kurzweil style futurism not withstanding, we are all acutely mortal. And yet culturally we strive so hard to deny this. In 2008 Medicare paid $50 billion for hospital and doctor bills related to the last 2 months of care, with a large proportion of this spent on unrealistic tests and drastic measures meant to squeeze out several days or weeks of life. My fear is that the quality of life for these extremely costly additional days is quite low, often spent in the ICU where 20% of adults now die. I would love to see us exploring ways to die at home (with hospice support if necessary) saving billions, shifting culture, and increasing dignity in the process.
- Western health care may not be as effective as we think: A World Bank study found that public health spending “explains less than one-seventh of 1% of the observed differences in mortality across countries,” that many developing countries have found ways to avert child mortality at less than 1/100th of the cost, and that “95% of cross-national variation in mortality can be explained by a country’s income per capita, inequality of income distribution, extent of female education, level of ethnic fragmentation, and predominant religion.” The Indian province of Kerela, for instance, has comparatively high income/gender equality and adult literacy (97%+), and has a life expectancy comparable to that of the US (75 vs 77.7 years). This is despite the fact that the GDP per capital for Kerela is well under $1,000 per year.
- It forces me to subsidize treatments I do not support: I spent several years of my life working with adults struggling with chronic psychosis. Most of them were medicated on a class of drugs called neuroleptics, which, after reviewing the evidence carefully, I believe quite often do more harm than good (see Robert Whitaker’s excellent Mad in America for a review). I am uncomfortable having my tax dollars support treatments that I believe are ultimately harmful, and, unfortunately, see this as a sizable portion of current American health care spending.
- It obscures the need for social and lifestyle shifts: In his excellent book Healthy at 100 John Robbins outlines the qualities of societies with a large number of people living healthy, vibrant lives at over 100 years old. The defining factors were access to sanitary living conditions, eating a plant based whole foods diet, regular exercise, avoiding drug abuse, and robust social connection and support. I am much more excited about building culture and choice architecture to support these factors than funding our current health care system as is. Which brings me to the next point…
- I value a cultural balance between rights and responsibilities: When Gandhi was asked what he thought of the Universal Declaration of Human Rights he replied, “all rights to be deserved and preserved come from duty well done.” I agree. If we have rights from other beings, then by extension we have duties toward them. I’ve struggled with weight gain my whole adult life, and when I watched Michael Moore’s Sicko I felt concerned that there was not more emphasis placed on personal responsibility. I would have loved to see him spend some time in the movie empowering himself to take care of his own health through eating fresh local produce and exercising. To my mind the normal progressive narrative is overly focused on social provisions for allopathic care, especially when demography shows that lifestyle changes can often be much more potent in extending life and healthspan.
- Our current practice of medicine is often toxic: Contrasted against lifestyle-based medicine (think walks in the parks, time with family, plenty of rest, and farmer’s markets) current medical practice consumes huge amounts of physical resources, and releases tons of waste into the environment, including dioxins and heavy metals.
- I would rather see the money go to directly support communities and ecosystems: Estimates of what it would cost to provide basic education, nutrition, shelter, and clean drinking water to the entire world run from 20 to 40 billion. Moreover, universal female access to education and decreased income inequality a 40 billion dollar global initiative would provide would almost certainly end population growth within 15 years, which I believe to be the single most important thing we could do to preserve our health as a species and biome.
When I meditate on my personal health, I see it as inextricably linked with that of the biosphere and global population. For me, universal health care is 95% about access to a fresh produce plant based diet, protection of biodiversity and natural capital, and a more just socio-economic world world, and I would love to see progressives steering the debate in this direction.