With the first round of health reform under our belts, it's time to shift attention from access to the real issue plaguing the American health system: cost. The cost issue is complex, spanning payment models, medical malpractice and defensive medicine, and the specialty versus primary care debate. But I want to focus on consumers, and the broader context in which they make their healthcare decisions.
A quick look at the list of the nation's most expensive health woes — which includes heart conditions, cancer, diabetes, and osteoarthritis — and it's hard to argue that consumers aren't at least partial architects of our own fates. Improvements in nutrition, exercise, weight control, stress management, smoking cessation, and sleep can put downward pressure on both severity and costs of all of those conditions.
Health plans, employers, and even policy makers aren't blind to the need to nudge consumers towards healthier behavior. But changing consumers' health behavior is hard. Program proponents bump up against consumers' self-awareness (most people think they behave better than they actually do), their perceptions (are they willing to trade off the short-term benefits of familiar habits for the long-term rewards of healthy behavior?), and even their psychology (consumers are risk averse, experiencing the pain of failure with more intensity than the joy of success).
All of this makes behavior change extremely difficult. But it's not even the whole story.
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