It's not how we die -- it's how we live

Commentary

Contrary to D.J. Tice's May 1 commentary ("Money will never buy immortality"), health care does not always "fail in the end."

I would propose that we are experiencing the results of the improvements in health care, which have resulted in people living longer lives and accumulating chronic and expensive health care problems.

No sane person I have ever met expected to cheat death and live forever. What most people aspire to do is to continue living the way they have been living as long as they can and then die quietly in their sleep.

Unfortunately, each reported "breakthrough" in medical science reinforces the attitude that patients can continue their often self-destructive lifestyles without regard to consequences.

I've heard teenagers say that they had no intention of quitting smoking because everyone they knew smoked and anyway by the time they developed lung cancer, there would be a cure.

The national health debate has focused solely on the means of paying for health care. Seldom has any discussion looked into what we are buying with health care dollars and whether we are spending wisely.

Political correctness has resulted in "someone else" -- whether health care insurers or the government -- being responsible for poor lifestyle choices. As long as people do not have to pay the real costs of their lifestyle choices, they have little incentive to change.

Most smokers who have a heart attack will be smoking again within six months. They expect that no matter what happens to them, they will be cared for -- and they are correct. Why should they quit smoking?

Our culture is perverse in that no one is allowed to die until they have expended all possible options to stay alive. Show me another country that puts $40,000 pacemakers in 90-year-old patients.

Show me a country where people with incurable brain damage, due to stroke or other causes, are kept alive on respirators or feeding tubes indefinitely while nursing home staff pour fluids in one end and collect them from the other.

We are running out of money to pay health care costs because we do not distinguish between illness and self-inflicted and hopeless diseases. We will continue to keep the body warm and blood flowing even when there is no hope for a return to function.

For many people, health insurance dollars have to compete with new boats, motorcycles and vacations in the family budget. Contrary to what the political class believes, people are not stupid. Build a system to contain costs, and they will figure out a way to benefit from it.

Recent data show that people on public assistance spend 27 percent of their benefits on cigarettes. Why not? What have they got to lose?

They know that every hospital in the nation has to take them in when they get sick. If they do not pay their medical bill, what are you going to do to them?

No country has imposed expectations upon the population because it is politically unpopular. Costs of health care should be reflected in the items that lead to bad health care outcomes.

Cigarettes should be costlier. People on public assistance who smoke should have their benefits deducted by $50 a month, to encourage them to quit smoking.

People caught soliciting for prostitution should have their names and pictures posted in the papers. The amount of public assistance for each additional out-of-wedlock child should diminish.

Along with stronger penalties for poor health care choices should be more public efforts for treatment of alcoholism and other drug addiction, free birth control, and even more public education and research into how to help people make good choices in regard to their health.

I am trying to say that there should be well-understood consequences for choosing self-destructive behaviors that include a high likelihood of dismal outcomes.

History would suggest that our country will continue to put off the inevitable until there is no other choice.

James D. Rusin, Anoka, is a physician.