A couple weeks back my grandma sent me a message on Facebook that was a picture of two very obese individuals eating a giant pizza and drinking soda. A caption on the photo read, “This is why I don’t want to pay for your healthcare.” As a person who is interested in and taken classes about public health and health policy, I actually think about these things all the time. I recognize the importance of making smart health choices, but I also understand that health outcomes can be a result of a complex web of social determinants of health. There are factors that are beyond our control in regard to living healthy, and there are some factors that seem like easy decisions to some people, that are monumental challenges to others. Despite the amount of time I spend thinking about these things, I don’t have a clear answer in my head for when people need a tough love kick in the pants versus compassion, and when a given outcome is generally more the result of poor individual decisions and habits or more the result of uncontrollable social determinants of health. There likely is no clear answer to this question, and I think it is reasonable to say, “I have thought about this a lot and I don’t know.”
This leads me to another factor that compounds the complexity of healthcare decisions: What choices, decisions, and behaviors are personal, and which ones should be considered public? If I chose to smoke, is that a personal decision even though there may be public consequences if I die early, have poor health overall, and require more emergency medical care which ultimately drives everyone’s healthcare premiums up? Do I have to exercise every day to stay healthy as a public good and not just as a private good? If I go get an x-ray on the ankle I sprained to make sure it isn’t broken, is that going to take time away from medical professionals who could help someone that really needs it when all I likely need to do is ice it a little bit?
In the book The Elephant in the Brain, Kevin Simler and Robin Hanson write about Steve Jobs and his decision to forgo cancer treatment as recommended by the American Medical Association’s best practices. Jobs is an interesting case because the fortunes of a company that many people love rested on his medical decisions. Beyond just his own health and the considerations of his family, people felt that they had their own money on the line if they owned apple stocks. If Jobs lived and survived his illness, it would be good for Apple, but if he denied standard treatment and died, what did that mean for the public?
“The point here,” write Simler and Hanson, “is that whenever we fail to uphold the (perceived) highest standards for medical treatment, we risk becoming the subject of unwanted gossip and even open condemnation. Our seemingly personal medical decisions are, in fact, quite public and even political.”
The kind of medicine we pursue and the lifestyle we live are never going to be restricted to just ourselves. We will at the very least be judged by others for our health and medical decisions. Our choices may or may not have major financial implications for other people, but that doesn’t mean that we can make our choices in a vacuum.
What is important to remember here is how complex the line is between personal and societal responsibility. Our individual decisions can have bigger impacts than we realize, and it is hard to keep something just within our own bubble. Added to that are questions about liberty and the authority of the state. It is not an easy question to ask if your diet should be controlled by anyone other than yourself, or if you should be forced to exercise and sleep a certain amount. Approach questions about healthcare understanding that these questions don’t have clear answers, and whichever choice we make is going to have strange consequences as a result of these complex inter-dependencies.