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FOR RELEASE: 12/11/2012

ACA and Obamacare give no nod to personal accountability for health choices


An opinion column by William M. Jennings, President & CEO of Bridgeport Hospital

While I was waiting to cross the highway at an intersection on the Post Road, two cars ran the red light and almost caused a massive collision. If it wasn’t such a common occurrence, such a daily life-threatening spectacle, I might have been shocked, if not outright angry.

Many states have installed camera monitors to catch motorists that run red lights. Why? The answer is simple: There’s a responsibility crisis in America.

That same notorious lack of responsibility has reached epidemic proportions when it comes to our health. The bottom line is that a million deaths a year are associated with poor diet, lack of exercise, alcohol abuse and smoking, and the price tag on the healthcare system is astronomical.

The healthcare industry will come under increasing pressure to control costs with the implementation of the Patient Protection and Affordable Care Act (ACA), but the one place we haven’t looked for savings is in our personal lives. As a society, we suffer from a widespread lack of personal responsibility when it comes to healthy lifestyles. The reality is this: We cannot continue to subsidize America’s bad habits.

And the ACA is decidedly silent on this critical component to reducing healthcare expenditures.

We’ve often heard it said that life is about choices -- good choices and bad choices, they are ours to make. But when it comes to personal health, we typically make the bad choices, whether it’s the fifth-grader in the school cafeteria reaching for the Skittles instead of that solitary apple in the vending machine or the chain smoker opening his second pack of Marlboros that day.

For decades, we’ve been educated about the pernicious effects of smoking, which is the primary preventable cause of premature death in America and costs $190 billion a year in lost productivity and medical costs and leads to 440,000 deaths.

For America’s 60 million smokers, quitting would save thousands of dollars, add years to their lives and prevent crippling illness. And yet, that message goes unheeded despite the proliferation of bans throughout the nation, the most recent being Mayor Michael Bloomberg’s prohibition of smoking in public parks.

We can’t legislate healthy lifestyles, although public health policy-makers and elected officials are trying. In recent years we’ve seen measures that eliminate junk food from school cafeterias and outlaw Big Gulp drinks. Consider the zeal of Mayor Bloomberg, a crusader for public health, who launched a campaign that banned soda in containers larger than 16 ounces.

It was a desperate measure to control obesity, and the New York City Board of Health in an 8-0 vote approved the ban, which was the first in the United States. As a result, selling large sodas and other sugary drinks will be prohibited in restaurants, theaters and street vendors.

While the libertarians yelled and cursed that Bloomberg wants to institute a “Nanny State,” the Mayor saw it as a health crisis that required government intervention, which, of course, begs the question – can the government force us to live healthy lifestyles.

It sounds excessive perhaps until you factor into the equation that more than half of all New Yorkers are overweight or obese, and an estimated 5,000 die a year because of obesity-related health problems. Bloomberg has been vociferous in championing similar causes, including requiring restaurant menus to display calorie counts.

We’ve heard the statistics so many times that we’re numb to the implications: Obese Americans are responsible for $150 billion a year in healthcare costs -- 9 percent of the total -- a price tag that has doubled in a decade. Within 8 years, that cost is expected to increase to $344 billion, or 20 percent of all healthcare spending.

This is why it is your business.

Where is personal responsibility? Where, for that matter, is the corporate responsibility on the part of fast food chains and junk food manufacturers? If spiraling healthcare costs are a crisis – and they are – manufacturers and restaurants have to become part of the national discussion.

One of the most terrifying reports by the U.S. Centers for Disease Control and Prevention is titled “F as in Fat: How Obesity Threatens America’s Future 2012.” It projects that by 2030, 13 states will have an obesity rate higher 60 percent of adults. And that $550 billion will be spent on healthcare over the next 18 years because of the rising rates.

At the same time, new cases of Type 2 diabetes will increase tenfold between 2010 and 2020 and double by 2030. The cases of stroke, hypertension, arthritis and heart disease will also rise.

The irony is that it doesn’t take much personal responsibility to change the tide. If Americans cut their body mass index by a mere 5 percent by 2030, billions in healthcare costs could be saved.

To be clear, there are some in our communities who have limited to no access to healthy, natural or fresh foods. These food deserts represent a far more complex societal problem than personal responsibility can solve alone. I understand and acknowledge this.

To its credit, the Accountability and Affordability Act does indeed have a provision which asks hospitals to conduct community health needs assessments, and then to establish specific local action plans based on the findings of the needs assessments. This is not a new concept. What is new, however, is that it is now required by the law. I am proud of the fact that even prior to this requirement, Bridgeport Hospital as a member of the Primary Care Action Group has been focused on the notion of defining and acting on the health needs of our community. The Primary Care Action Group (PCAG) is a multi-agency regional cooperative. They have already identified obesity as a significant health care issue in our community. In fact, over a year ago, the PCAG launched Get Healthy Connecticut, a regional coalition aimed at increasing access to healthy foods and increasing physical activity in the community as a way to reduce obesity.

I will be shocked if health issues caused by individual’s weight and personal healthy lifestyle choices does not rise to the top of the most critical needs in our community based on the current PCAG study.

Our country has spent more than two years in agonizing debate about the healthcare reform law. What is needed now is an equally intense discussion at all levels – legislators, the healthcare industry, food manufacturers, restaurants and ordinary citizens -- as to how we can return a measure of personal responsibility to the American mentality. That, clearly, is where one of the most direct and true solution to reducing healthcare costs lies.


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Part of Yale New Haven Health System, Bridgeport Hospital is a 383-bed acute care hospital (plus 42 beds licensed to Yale-New Haven Children’s Hospital) serving parts of Fairfield and New Haven counties. The hospital admits more than 18,000 patients and receives more than 240,000 outpatient visits annually.