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The Right Prescription

Unhealthy Choice

Personal responsibility and the health care debate.

Of the countless reasons for our health care crisis, one, a lack of personal responsibility, has been getting short shrift. It certainly failed to get a single mention in President Obama’s health care speech last week.

Likely it is because the whole concept of personal responsibility and its cousin self-reliance get short shrift. Once as American as pumpkin pie, personal responsibility has slowly been whittled away to the nub of an idea. When New England farmers — the original and definitive self-reliantists — began accepting farm aid and relying on government handouts, you knew it was over.

The problem was “briefly” addressed in the Republican response to Obama’s speech. Louisiana Congressman Charles Boustany angered those few newspaper columnists left when he said: “I operated on too many people who could have avoided surgery if they’d simply made healthier choices earlier in life.”

Sadly, what Boustany did not say was something to the effect that my health is my responsibility, not my government’s. He also failed to mention that 75 percent of the $2.1 trillion dollars spent in this country last year on health care costs were for chronic diseases such as heart disease that are largely preventable and even reversible by changing diet and lifestyle. No, that was mentioned by Dr. Dean Ornish, founder and president of the Preventive Medicine Research Institute.

By the time the morning edition landed on the lawn, apologists had fired back at Boustany with a litany of pretexts for being fat and lazy as long as my arm. Mary Schmich — who certainly looks healthy judging from her mugshot — had more excuses than a pregnant nun: “A lot of people don’t have a wide set of… healthy lifestyle choices,” wrote Schmich in the Chicago Tribune. Schmich interviewed an “expert” who observed that “not everyone can afford to buy organic, join the gym, live in a walkable neighborhood.”

Schmich and her expert are being disingenuous. She is erecting a whiny, politically correct straw man in the hopes of drawing attention away from the issue. Rep. Boustany was certainly not referring to those with genetic predispositions, or the poorest of the poor who live in drug and crime-infested areas where supermarkets and organic farmer’s markets are few and far between, and cannot afford gym memberships. (By the way, I know of a gym everyone can afford. It’s called the outdoors. I use it every evening.) Nor was he talking about the few folks who live in the bayous and Appalachian hollers and in Death Valley trailers.

No, he was talking about average Americans who weigh way above average.


SCHMICH ALLEGES that we are too busy to eat well, and — allow me to paraphrase here — that you can’t expect us to turn off Gossip Girl and go for a brisk walk ‘round the block; that you can’t expect us to stop smoking or stop at two drinks; that you can’t expect us to bring a healthy lunch to work when you could order in a pizza with extra toppings. Besides somebody has to bring in Krispy Kreme donuts every morning or how are we going to get motivated to sit our big butts down in front of the computer? Rep. Boustany is not being fair. He’s for punishing the poor. And the lazy. And the obese. In other words, punishing the victims.

Of course, who is really being punished are those Americans who maintain a healthy lifestyle and then have to pay the medical bills of those who won’t.

In a piece in the August 12 Wall Street Journal, Whole Foods CEO Jim Mackey offered a modest proposal that upset more than a few liberals: “Rather than increase government spending and control, we need to address the root causes of poor health,” he wrote. “This begins with the realization that every American adult is responsible for his or her own health.”

Mackey’s op-ed resulted in a call for a nationwide boycott from its liberal base of shoppers. The Boycott Whole Foods’ Facebook page now has nearly 34,000 members, all of whom seem offended by Mackey’s suggestion that government-run health care is not a human right.

I have always chafed at the government telling motorcyclists or bicyclists that we have to wear helmets for our own safety. Such laws, however, have always been embraced by liberals who note that the taxpayer might have to pay for your hospitalization, surgery, and rehab should you suffer a head injury. This liberal logic, however, doesn’t seem to apply to other types of reckless behavior, like shoveling two Big Macs down your gullet every day for lunch. Suddenly it is not an issue of taxpayers being made to pay for others’ reckless and stupid behavior. It’s an issue of punishing society’s victims.

I realize it is not easy to be healthy in this country. It takes a genuine effort. With the exception of produce sections, supermarkets stock mostly unhealthy foods, full of sodium and fats, because that’s what most of us continue to demand. Some towns — my own hometown, for instance — have chosen to ban farmer’s markets in an attempt to lessen the competition on brick and mortar grocers. Here in the Midwest we’ve chosen to design our cities and towns with few if any sidewalks and with wide, fast streets in what seems an effort to discourage walking. With both parents choosing to work, no one has the energy to cook slow, healthier food. And forget about trying to eat healthy in a restaurant. Brown rice? Whole wheat pasta? What are you, a comedian?

We libertarians would never dream of telling people how to live their lives. You want to smoke a carton of cigarettes a day, let me get out of your way. But when the day comes — and come it will — don’t expect me to pony up for your open-heart surgery with a public option.

About the Author

Christopher Orlet writes from St. Louis.

Letter to the Editor View all comments (76) |

Darin| 9.17.09 @ 7:04AM

I find it interesting that many of the same people who say a woman should be given the "freedom of choice" to destroy her unborn child want to deny that "freedom" to others to eat "unhealthy" food. Abortion has medically proven adverse results (breast cancer, etc.), so it can be argued that abortion is "unhealthy" much as various fast foods.

Appleby| 9.17.09 @ 7:24AM

I have always thought that health insurance ought to work like life and auto insurance -- fitted to the lifestyle and habits of the person in question. A person who is likely to put in more claims ought to put in more cash.

Insurance policies should also be designed with exclusions of illnesses caused by lifestyle choices. This would bluntly inform people in plain words that they are free to make these choices, but the fallout will land on their own heads.

Yes, the Marching Mommies will start screaming about TheChildren -- if Mommy wants to lard up her bottom with two roast chickens and a diet coke every meal, why should TheChildren be *punished* when Mommy collapses from heart attack and stroke?

Well, Mommy punishes those kids if she pours down a six-pack and gets in a car accident on the way to the liquor store, does she not, when the insurance money is denied because the wreck that killed people in the other car, too, was 100% Mommys fault?

Life insurance commonly excludes death through participating in dangerous sports, and homeowners insurance does not cover the laboratory in the basement.

P.S. For those who claim they need a gym membership in order to work out, why do you not try bending and picking up the litter your kids just dropped all over the floor of the subway, or walk the four steps to the trash can instead of dropping your Starbucks cup on the platform?

JP| 9.17.09 @ 9:02AM

What worries many people (both liberal and conservative) is that today, through genetic testing, doctors can determine what types of diseases people are pre-disposed to. With that kind of information in mind, people of good will can argue that a person with a genetic predisposition to say heart disease would find it impossible to get affordable health insurance - no matter what his life style. The famous case of marathon runner Jim Fixx is a case in point. He died of heart disease at 48, despite being a competitive distance runner.

I have known several people who niether smoke or drink and who avoid unhealthy food, and they still required expensive operations for heart disease.

Things like auto and home owners insurance are directly related to behavior. Health insurance statistically can be tied to life styles, but only to a certain point. The late Senator Kennedy was overweight and drank heavily for years. He lived until he was 77. Patrick Swayze was a very fit dancer, rancher, and as far as I know he lived a "healthy life". Yet, he contracted Cancer when he was 56. Dick Cheney had heart problems in his 30s.

teri| 9.18.09 @ 7:30PM

Leave it to Liberals to be judgmental elitists. I eat better than you! Look at me, Ma, see me ride my bike? Aren't I being a good boy!? Pat me on the back and a pox on you inferior overweight people!
I thought there was a group to fight discrimination against obese? Where are they now? I haven't heard a peep out of them while people like Christopher turn fat folks into scapegoats.
And isn't the whole point of a gov't option to get everybody covered? So what now, the fatties will be the new class of unisured? The dems are dying to rake in lots of Mexicans- are they going to be told to stop with the tortillas and beans and all those beers after work? I hope so- nothing will get them to vote Republican faster.
Where will the nannies stop? Will they soon be requiring us to drink at least 8 glasses of water a day? Get our colons detoxified on a weekly basis? Put a sweater on if the temp outside is below 60 degrees? God forbid they have to pay for me if I get a runny nose!
This is absolutely why we should NOT ever-ever, ever have a gov't option. Keep your nose out of my business and if I want your opinion I'll ask for it.

Sheila| 9.17.09 @ 10:10AM

Along with the death of the protestant work ethic came the death of personal responsibility. Now we have entitlements and self esteem, instead. Darin, you may eat whatever you wish to purchase with your own money; you may also pay for your clogged arteries and added bulk the same way. I don't think motorcycle riders should have to wear helmets - I think they're all absolutely insane, but as adults they can make the choice to engage in whatever risky behavior they wish. The key, which most commenters miss, is that they assume the costs associated with such risks. As Chesterton noted, "A free man owns himself. He can damage himself with either eating or drinking; he can ruin himself with gambling. If he does he is certainly a damn fool, and he might possibly be a damned soul, but if he may not, he is not a free man any more than a dog." The unspoken corollary to this quote is that such freedom comes on one's own dime. Don't agonize over genetic risk and inherited tendencies; those are also covered under the "free" and "on your own dime" provisions.

Yes, I know I'm heartless and obviously not yet elderly enough to be as worried as some think I ought to be (51); I'm also a free American woman who refuses to be protected from herself by either the government or society at large. Do gooders, be damned. Free will, anyone?

Etiquette Man| 9.17.09 @ 10:10AM

As a libertarian and a "person of girth," I note with amusement that I have never heard of an obnoxiously self-righteous "libertarian" before.

I always thought that looking down your nose at other people and affecting airs of superiority was an exclusively LIBERAL trait.

So thank you, Mr. Orlet, for teaching me that a fellow libertarian could be every bit as cloyingly superior as Nancy Pelosi after yet another botox injection.

Who knew?

Ironically Yours,
EM

Faffnir| 9.17.09 @ 10:32AM

I have been unemployed since January and came to be very dissatisfied with the shape of my shape. After some rummaging around in the interweb, I found the old RCAF 5BX program. I started six weeks ago. In the time it takes to brew up a pot of coffee (Jacobs Kroenung, thank you very much) I do my excercises. I have already lost two inches from my waist and my knees are not as stiff and sore. I also walk twice around the block on alternate days. You needn't spend money on a fancy gym to get in reasonable shape.

Tim| 9.17.09 @ 10:58AM

You guys are all missing the advantages of gubmint health care: us fat bastards will be packed off at taxpayer expense to rural Alaskan spas where we will have to fight each other for rotten potatoes and muddy water. We will break rocks all day for roadbed construction and shiver through long, frosty nights under our taxpayer provided blanket.
After six months to a year we will be returned to our communities, lean and well muscled, purged of all our diet vices and well schooled in bear evasion.

Faffnir| 9.17.09 @ 11:20AM

I have been unemployed since January and came to be very dissatisfied with the shape of my shape. After some rummaging around in the interweb, I found the old RCAF 5BX program. I started six weeks ago. In the time it takes to brew up a pot of coffee (Jacobs Kroenung, thank you very much) I do my excercises. I have already lost two inches from my waist and my knees are not as stiff and sore. I also walk twice around the block on alternate days. You needn't spend money on a fancy gym to get in reasonable shape.

Tom Fry| 9.17.09 @ 11:30AM

Before anyone else in the world discusses prescriptions for obesity, heart disease, etc. I really wish they would update themselves on the actual science behind their conventional wisdom based claims (i.e., ' ...they should exercise, reduce caloric intake and avoid fat,etc...'). At that point we could begin to at least have a rational discussion of the subject. If interested in learning start here: http://www.amazon.com/Good-Cal.....1400040787

BTW, I fully endorse the personal responsibility idea, just not the nanny like hectoring advice to follow conventional nutrition and exercise prescriptions which the available science indicates are highly suspect.

Tom Fry
St. Louis, MO

CPAP Therapy | 9.17.09 @ 12:36PM

Why is whole wheat pasta and brown rice considered healthy? It isn't. Its part of the problem.

Marc Jeric| 9.17.09 @ 1:26PM

I thought, with reason, that the boss of Whole Food Markets was a typical California eco-nazi, and after a couple of visits to his market here in Las Vegas decided to avoid it. No, however, he says that government should not support our unhealthy eating habits, and is immediately attacked as an enemy of the people. Perhaps I will visit his market again.

Paul Crowley| 9.17.09 @ 2:23PM

Well done, thou ignoble servants. . .

Personal Responsibility has been given anything BUT "short shrift" in recent years

It's been preached, ad nauseum, by the left and right, especially over the past 20 years, and increased in the past ten or so.

As to presidents, then Bush preached it regularly, nad so has Obama.

As to the speech, then Personal Responsibility is the very essence of why the term medical care has been discarded, wiped from the vocabulary of most Americans, propbably from the vocabulary of all under the age of 45, and replaced by by the term Health Care.

Premier in the theme, where medical care has been concerned, has been the almost psychotic emphasis upon Prevention, for at least the past 20 years.

As if human beings are motors, kept up with routine preventative maintenance, refurbished with corrective maintenance, and then discarded when beyond further repair, or when the cost of a new motor is cheaper than that of repairing old one.

People age and deteriorate. It's unavoidable. It's also variable, individual to individual. It's unavoidable that some people will become chronically ill, for which there is no preventative "health care" that is any use.

The comment writers here are clearly doing their part to advance the final transformation of American medical care (now reformed into Health Care), into a behavior-regulation and population control scheme.

It can be done, as the Brits, French, and Germans currently do, via national Health Care programs (which use precisely what is argued for in these comments to regulate medical care, or control human action), or it can be done, as the Dutch are demonstrating, and as we've been moving toward, with so-called private Health Insurance.

Mandating the purchase of medical insurance can be used in the same manner that national health care is used by the British, such as a basis to deny immigration to a man's wife (e.g. due to obesity, based upon pre-defined body fat content standards). In the British case, due to her supposedly being an excessive burden upon the tax payer. In the Dutch or American case, its not hard to see that it would be unfair to the insurer, or both the insurer and tax payer, given the system being proposed.

At any rate, the Libertarians here at The American Spectator, including the professional comments writers, tasked with conserving the social revolutionary gains of the past 45 years, are clearly doing their 'bit' to advance the scheme for the regulation of American Human Resources. The term is eugenics, not Personal Responsibility (a euphemism as absurdly non-descriptive of what it actually advocates as Choice). Effectively it is Human Husbandry.

Ken (Old Texican)| 9.17.09 @ 2:39PM

Paul...go take your medication.

Back on point: This broad named Christopher that wrote the article above is hilarious!

Those "naturally grown crops" have BUGS, and VIRUSES, and MOLD! They kill people.

I quit smoking cigarettes in 1978. Started smoking a pipe...which I inhale like a chimney (smile...cool metaphor, no?) My life insurance premiums are the same as yours if you are my age and male.
Those hard-eyed actuaries in the insurance companies don't see me as a threat.

Heh! I shall probably die of ACORN bullets!

Paul Crowley| 9.17.09 @ 2:41PM

"I have always thought that health insurance ought to work like life and auto insurance" [Appleby| 9.17.09 @ 7:24AM]

If this is what you've "always thought," then you should be happy.

Beyond the fact that purchase of liability auto insurance is also mandatory, thin this is precisely the direction that American medical care is proceeding.

Medical care is already being Regulated via so-called private Health Insurance.

You also give the example of how insurance can be used to Regulate Human Behavior, which is precisely what you advocate.

As to any implications, or statements, of any overt individual choices, then those are only rhetorical flourishes.

Flel| 9.17.09 @ 3:50PM

Auto insurance is not mandatory. The registration in CA states you must have insurance or other means of bonding for liability. Why do we have un-insured motorist coverage added to each policy if it is required? Is it because there are those that will not comply? It should be optional just as any other insurance should be optional. If I choose not to insure my life that is my business. The same goes for my home and possessions. We all have different levels of risk tolerance and the govt is not supposed to tell me what those levels can be or be there to help me out when I am down. If the govt only supported the military for our security that would be more than enough in my book. They would need about 2 or 3% of our incomes to achieve that and leave us to our own devices. We don't need their help with medical care, education, energy, etc... This is not insurance reform. This administration and Congress don't seem to know what insurance entails. They ought to read a definition sometime before they think they can reform something they know so little about. Insurance involves risk and they are trying to remove risk from the calculation. Can't someone make the govt leave us alone for a while?

Pingback| 9.17.09 @ 4:07PM

The American Spectator : Unhealthy Choice | Finally! Be free from smoking links to this page. Here’s an excerpt:

The American Spectator : Unhealthy Choice | Finally! Be free from smoking Finally! Be free from smoking Home The American Spectator : Unhealthy Choice January 1, 1970 Peter Parker wrote an intriguing post today on Here’s a little taster He also failed to mention that 75 percent of the $2.1 trillion dollars spent in this country last year on health care costs were for chronic…

Dai Alanye| 9.17.09 @ 8:00PM

Scratch a Libertarian, find a totalitarian. Just a different kind.

Kurt| 9.17.09 @ 8:16PM

The 'genetic predisposition' may often times be a result of learned behavior. If one buys into the concept of-both my parent are fat, therefor I am fat, it's genetic-they would be correct. However; in this case genetic predisposition could very well be caused by lifestyle and dietary habits. Who draws the line and where? Certainly conditions caused by inbreeding are a genetic predisposition. There is no answer, there is no fix. Unless you subscribe to the cure of a junkie being he gets his heroin 'fix.' Tomorrow he will need another as sure as the federal government will want to fix this latest reform as soon as they see an opportunity to get or buy a vote out of the latest 'fix.'

DOUGLAS FIELD| 9.17.09 @ 9:19PM

* THE FINE ART OF DENYING 45 MILLION AMERICANS HEALTH~CARE IN OUR JUDEO~CHRISTIAN NATION *

AMERICAN RELIGIOUS LEADERS ALL ACROSS THE USA HAVE ALWAYS BEEN ABLE TO COUNT ON THEIR RELIGIOUS FLOCK TO CONTRIBUTE(TITHE)THEIR HARD EARNED MONIES TO THEIR MINISTRIES EVERY WEEK.

THE MAJORITY OF AMERICANS ATTENDING RELIGIOUS SERVICES IN THE U.S. ARE MIDDLE~CLASS AND WORKING POOR CITIZENS WHO NOW DESPERATELY NEED THE HELP AND SUPPORT FROM THESE SAME U.S.RELIGIOUS LEADERS IN LOBBYING THE U.S.CONGRESS TO PROVIDE PROPER HEALTH~CARE FOR ALL POORER AMERICANS.

***THERE ARE CURRENTLY AN ESTIMASTED 45 MILLION MEN WOMAN AND CHILDREN WITHOUT HEALTH~CARE IN THE WEALTHIEST COUNTRY IN THE WORLD????

SILENT AMERICAN RELIGIOUS LEADERS WHO ALL HAVE HEALTH~CARE FOR THEMSELVES AND THEIR FAMILIES IS MUCH MORE FRIGHTENING THEN THE POSSIBLE DENIAL OF A FUTURE HEALTH~CARE PLAN FOR ALL...

LAWYERS FOR POOR AMERICANS (424-247-2013)

Mary Louise| 9.18.09 @ 12:30AM

Always appreciate your essays.

Personal responsibility is so important. Besides the points you make, taking charge of your life helps to eliminate fear and can help make you more courageous.

Social security, Medicare, etc. all contribute to the problems that health care reform is supposed to alleviate. Without these programs people would have to save, and they would have to understand that life naturally ends when it ends.

Now we're faced with the likelihood that a bureaucrat will help you make that decision. I have elderly parents, who have serious health issues and they've had no problems with their health insurance that are worth complaining about.

Apparently, one of the horror stories the President hawked in his speech in order to castigate the insurance companies isn't quite true. And he and those like him are supposed to merit our trust? Whatever horror stories that are true and that do exist will not be eliminated by a new brand and band of bureaucrats who offer no means of petition. They want to trade one set of 'losers of life's lottery' for another. It's an old game. A power game, and to tweek a Steely Dan song, 'only a fool would fall for that.' Skunk Baxter on guitar; hes' great! I think the name of the song is 'Only A Fool Would Say That.'

Keeping people alive well after they would have passed away unsettles a balance. Couple that with aborting millions, and you have a society that's retrograde.

Nursing homes are so depressing, and so are day care centers. The warehousing effect really hits me when I enter either one. I can’t wait to get out.

I had to go to Italy a few years ago to help my aunt. She never married and was alone. She'd earned her living like a man. She went into the forest with donkey and axe, chopped and bundled wood and sold it as kindling.

It broke my heart to take her from her home and put her in a nursing home. She called me the next day: please bring me home, please bring me home, please bring me home. She suffered from mental illness, and that made her living alone an impossibility. But she's doing fairly well now, all things considered.

Her nursing home, however, is a very large, older home that at one time was the property of a prominent family. Sheep play freely in the back field, the Apennines surround her, and she couldn't get a bad meal if she requested it.

In my line of work I get a lot of calls from the elderly. I sometimes have a need to ask them if one of their children might be able to do this or that for them. They're like little kids with none of the promise.

Mary Louise| 9.18.09 @ 12:33AM

Should read tweak.

Don L| 9.18.09 @ 5:59AM

The real danger to this nation comes from ideologues that are very personally responsible for their actions.

Let's not get sidetracked with the couch potatoes are our enemy until the big battle is won.

Remember how fit and resonsible those Nazis, the Japanese, the Viet Cong, the North Koreans, and the 9/11 guys were.

Curtis| 9.19.09 @ 12:27AM

The health food nazis are avoiding one major fault. The foods aren't unhealthy because we have major massive sweet tooth's, its due to logistics.

Salt? Preservative. High Fructose Corn Syrup? shelf stable for years. Boxed meals? They last forever.

If we all go vegan organic, we all starve. Its not sustainable. There have been many revolutionary inventions in farming and trans, but the fact still remains that vegan and 'natural' foods can't be grown in great enough scale, and can't last on the shelf long enough to sustain the nations demand.

So go ahead health nazis, ban the salt and sugars and HFC. Put an end to genetically modified crops and hormone treatments for livestock. Force the farmers to abandon pesticides and fertilizers. I've never seen mass starvation before. I've never seen anyone try to beat Stalins' kill count for that matter. Ramp up production of corn based ethanol while you're at it. Either way, I've only got a good fifty years or so left on me, might as well make it entertaining.

In the meanwhile, define healthy. I'm 125 pounds and 5foot 9, standing at an 18 BMI, 20 is 'normal' for my height. I need to gain weight. All these no fat, no carb, no calorie programs are beating me to death. You're health food ain't healthy for me.
I need those carbs and calories. I could use a little fat. I'd take yours if I could.

Fat is to health what global warming is to the environment. Its an over simplification of the issue. We used to say "eat a balanced diet and exercise." We also used to say " protect the environment" Now we freak out about pounds and ounces and calories the same way we freak about CO2 emissions while ignoring all the other stuff that is going on.

Much the same way my coworkers hassle me for smoking, when they all chew tobacco. Its not hypocrisy; its idiocy.

Oh, and BTW. Our major issue isn't that people are fat. Its that people age, and eventually die. They have a tendency to require alot of expensive treatment in the years prior to that last step. Living unhealthy life styles just seem to fast track them to those last steps a little bit quicker then usual. But hell, just think of the money we save on social security and medicare. Every fatty who drops dead of heart disease at age fourty is one less medicare recipient I have to pay for on my paycheck. If your lucky, I'll buy it from emphysema long before I ever collect a medicare check.

Gwendolyn| 9.20.09 @ 12:26AM

Look up Nourishing Traditions. Please don't put your health in the government's hands. Sounds like you believe in their definition of "healthy". They're not really looking out for you.

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Andri | 7.16.10 @ 10:55AM

Sometimes in life we did see the choice we took is bad. But, we kept going on with it since that the best choice we can make at that moment! Great post! thanks

Boby | 12.17.10 @ 2:59AM

I agree with that the healthy is first thing come for me. Today all people interested in Healthy life such as Yoga Or Vegetarian. Thank you.
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