While writing a story on health IT earlier today I was suddenly struck by how important psychology is as an element in health reform.
We are accustomed to thinking about our health only when it’s necessary. When we get sick it’s uppermost in our minds. When we are not it’s out of our heads completely.
In practice this means young people hardly give their health a thought, while as we age it becomes an obsession. I’ve noticed this in myself, and chose this (rather ugly) self-portrait from a few days ago to illustrate the point.
I turn 55 next week. (Thanks.) The old double-nickel. I wonder a lot whether I will ever feel as good as I do now, and so work hard to maintain myself.
I notice what I eat as I never did before. I exercise regularly. I take supplements. I listen to my doctor. Conversations with my wife often involve subjects like sleep patterns and medication schedules young people find boring.
I suspect this is true for most people my age. A cocktail party among 50-somethings will feature a lot of conversations about health procedures, wellness and bodily functions 20-somethings find icky.
But at the heart of health reform, as business and government both now perceive it, is the idea of preventing procedures by making us all think about ourselves as I do at 55. Which is to say, regularly.
At the heart of “meaningful use” is collecting data on patients, not procedures, and getting that data into peoples’ hands so they can act on it.
We want everyone to pay into the system, regardless of age, so we’re going to be offering everyone regular checkups and other wellness services that seem like a pain at 25 but are gratefully accepted by us oldsters.
We know that if you have good health habits as a young person you will maintain them. This makes you less liable to become obese, less likely to smoke, less likely to do drugs like alcohol, and less likely to get cancer, heart disease or diabetes.
Chronic conditions like these are bankrupting our current health care system. Just as with cars, businesses have learned it costs less to maintain people than to fix them when they break. So they want to intervene with us, only they want someone else to lead that intervention.
This is the psychological dimension of health reform. Accept this premise and the system naturally transforms. Incentives change if insurers must accept everyone. The route to higher profits becomes wellness.
Incentives also change within the profession. Demand for general practitioners, for hands-on wellness coaching, goes up, and over time demand for specialists goes down. So does demand for hospital beds, when measured against population, and for treatments.
All this is the economic result of changing our psychology regarding health, from the blithe disregard of a 25 year-old to the healthier obsessions of middle age.
It’s a big ask. You are telling people to take responsibility for things they may not care about, things they may well think are none of your business, their most personal habits.
This is true no matter how who pays for it, or how the message is delivered. And I think it is behind the fierce resistance to any type of health reform, no matter how “conservative” the final bill is seen to be by liberals.
Changing finance mechanisms, changing computing paradigms, changing market incentives, they’re all in service to changing psychology.
And find me someone who thinks they are well but welcomes having their psychology changed from that of a 20-something going blithely through life to a 55 year-old drudge like me.
Better for them the status quo, even if it’s unsustainable. So, in the end, is life.
