It Is Your Duty To Maintain Wellness

DrRich | August 15th, 2011 - 7:26 am


DrRich considers it his responsibility to point out to his readers certain truths related to modern American healthcare which may not be obvious to everyone, and which the fine people in the mainstream press choose not to mention.

Be honest. If it weren’t for DrRich, would you be aware that the only reason Obamacare became the law of the land is that the private insurance companies needed it in order to have any hope of long term survival?  Would you understand that the Progressive healthcare system to which we are now legally committed inherently requires all of the following things (while loudly proclaiming the opposite): ending the classic doctor-patient relationship; preventing individuals from spending their own money on their own healthcare; killing off the practice of primary care medicine; to the furthest extent possible, limiting preventive medicine; and stifling medical innovation?

One thinks not.

And so, DrRich hopes you will pay attention as he reveals yet another poorly-appreciated truth about our new healthcare system. Namely, it has become the case that maintaining your own wellness is not merely something which would be desirable, something you ought to do, or at least something you ought to want to do. It is now your duty.

You owe it to society to maintain your wellness, to take every step at your disposal to keep yourself from needing to consume healthcare resources. You owe it because healthcare is now a collective responsibility. And if your chosen actions (or inactions) cause you to become unwell, and if your unwellness causes you to consume healthcare resources which otherwise might have been available to individuals who (unlike yourself) became ill through no fault of their own, and if such faultless individuals subsequently suffered or died as a consequence of your failure to honor your duty, well then – that would make you no different from any other common criminal whose selfish actions produce harm to their innocent victims.

Maintaining your wellness is not a nice-to-have; it is your non-negotiable obligation.

You have been told that your wellness is very important to the caring people who will run our new healthcare system. And indeed, it is. So you will, by law, be “entitled” to annual, detailed “wellness checks,” provided by a dedicated team of healthcare workers, who will assess (and record) your efforts to maintain your own wellness, and then will give you all the instruction you need to alter whatever suboptimal behaviors you are displaying. The results of these annual wellness checks will be entered into a federally-approved universal electronic medical record, so that any healthcare provider, anywhere, at any time, will have a complete record of the trajectory of your state of wellness over the years – and of the degree of your compliance with the instructions you have received for maintaining that wellness.

Of course, if you elect to forgo the annual wellness checks to which you are entitled, that information (i.e. that you cared so little for your wellness that you couldn’t be bothered to do anything about it) will also be maintained in the universal electronic records.

Then, when you become ill 10 or 20 years from now, your records can be consulted to decide to what extent your illness can be considered self-induced. For, when resources are scarce, the only moral thing to do is to distribute them according to who is the most deserving.

Most readers are now thinking that DrRich is paranoid. Guilty as charged. However, DrRich’s paranoia, regarding the kinds of behaviors of which our Central Authority is capable, is based on hard experience. Indeed, it is evidence-based.

Still, DrRich is enough of a realist to understand that it is unreasonable to ask his readers to just trust him here. Instead, let’s examine patterns of behavior, regarding supposedly self-induced disease, which our society is already displaying. The best example, one which DrRich has written about extensively, is obesity.

We are witnessing a sustained and ongoing campaign to demonize the obese. Consider: While we are universally urged to stifle any impulsive speech or sentiments which, by any stretch of the daintiest of sensibilities, might make any member of any group (however you choose to define a group) the least bit uncomfortable, it is perfectly OK to castigate the obese, loudly and often. We can say about the obese anything we like.  Screw their feelings. It is perfectly fine to insist that it is the obese – gluttonous, lazy, self-indulgent, slothful fat people – who are driving our healthcare spending off a cliff. It is acceptable to publish ridiculously flawed papers in respected scientific journals proving that global warming is caused by the obese (thus pinning upon them the responsibility for upcoming catastrophes of unimagined proportions), and demonstrating that obesity is a contagious disease (which will justify any actions we may choose to take to concentrate the obese into special camps).

A person’s choice to allow themselves to get fat already justifies more than mere words of castigation. Under the British Health Service (the model to which Dr. Berwick and other of our current healthcare heroes openly aspire), the obese (along with smokers, another group of selfish sub-humans who use an unfair share of healthcare) are now being removed from the waiting lists for medical services.* By virtue of their obesity (and the lack of social responsibility their obesity indicates), fat people have forfeited their equal access to healthcare.

*Removing the fat from the waiting lists has at least two beneficial effects. It punishes them, of course, for their selfish refusal to maintain their own wellness. But it also reduces the long waiting lists that exist in Britain for medical services, closer to the target waiting times which the government has been promising its citizens for decades.

Demonizing the obese has many advantages. Chief among these is that the obese are easy to spot. In contrast to the Jews of Nazi Germany, one does not have to sew a Star of David to their jackets to know which individuals are wrecking the culture. By just walking down the street (not that fat people do all that much walking, lazy SOBs) they reveal themselves, by their unsightly corpulence, to be one of those people who are ruining the healthcare system for the rest of us. And we svelter, more worthy citizens can look upon them with the scorn they deserve.

Especially now that we have so many programs and policies aimed at preventing obesity – putting apple slices in Happy Meals, publishing calorie counts in restaurants, being lectured at by First Ladies and skinny movie stars, &c., – anyone who still chooses to remain obese despite all this abundant assistance must be especially contemptible.

Perhaps most useful of all, in the long run, is the fact that real, honest-to-goodness, health-threatening obesity almost always has a strong genetic component. When we learn to demonize the obese, we are learning that wellness is a duty even if your genes (or some other force that is largely beyond your control) mitigates against it.

The obese, therefore, are the perfect target. Thanks to them, we are teaching ourselves that it is right and proper to disdain individuals who are leading less than exemplary lives.

Once we have learned this lesson well, it should be relatively easy for us to apply the same kind of disdain to others who who fail to honor their duty to maintain their own wellness. Most of these scurrilous individuals will not be so obvious to spot as fat people.  But at the end of the day, they will reveal themselves in the ultimate manner – they eventually will fall sick. And by their diseases we shall know them.

For the past several years, our healthcare experts have been busy declaring more and more illnesses to be “preventable.” And if an illness is preventable, and an individual fails to prevent it – well, what more do you need? That person has obviously failed to perform their sacred duty to society, and has forfeited any claim to the healthcare we more deserving people can expect.

The list of illnesses which are officially preventable now includes coronary artery disease, heart failure, kidney failure, diabetes, stroke and many kinds of cancer. And just a week or two ago, Alzheimer’s disease was added to the list.

It is possible that in a decade or so, if you acquire an illness from this growing list of “preventable” medical disorders – especially if your annual wellness checks reveal that you have gained weight since college, or you habitually fail to exercise at least 90 minutes per day, or that you imbibe less than one or greater than two alcoholic beverages per day – you may be triaged to Tier B healthcare. Tier A will be reserved for people who obviously care more than you do about wellness, and about their duty to society. Just as obesity does today, the state of your health will demonstrate your true commitment to the perfect society to which we all aspire.

For, when it is your duty to maintain wellness, your illness reveals a grave dereliction.

8 Responses to “It Is Your Duty To Maintain Wellness”

  1. Bob C says:

    I guess it’s not a large jump from ‘never’ events in hospital medicine to ‘never’ diseases in individuals. No government dollars shall be wasted on those conditions or events which in some cases might be preventable. No matter that there is a certain irreducible level which can never be prevented or successfully reversed. As to obesity, when the best medical centers in the country have less than 5% success rate at getting the obese to achieve normalcy and keep it for greater than 3 years. What are we to expect of those poor unfortunates who cannot avail themselves of that level of care?

    • DrRich says:

      Bob C,

      “Never Diseases.” I wish I had thought of that.

      As for your second point, we must stop thinking of the obese, or those who allow themselves to acquire preventable medical problems of any kind, as “those poor unfortunates.” Such misplaced compassion for what are fundamentally derelicts will tend to prevent us from having right thoughts and taking right actions. You obviously have not completed your re-training yet.


      • Michel Accad says:

        “Never Diseases…” That’s great…But I suspect there will always be politically correct “diseases” (alcoholism, depression, etc…) for which the standard won’t apply (I guess their “genetic component” will be emphasized).

        Dr. Rich, it is not “re-training” that Bob C needs to complete. The operative term is usually re-education…

  2. An MD says:

    Nice piece. Saw it coming a mile away. You may enjoy this editorial from NEJM 1994, when,apparently, it was a completely different journal

    “The Tyranny of Health” Faith Fitzgerald

    Membership may be required for full text …

    But here is the final paragraph –

    “We must beware of developing a zealotry about health, in which we take ourselves too seriously and believe that we know enough to dictate human behavior, penalize people for disagreeing with us, and even deny people charity, empathy, and understanding because they act in a way of which we disapprove. Perhaps the health care crisis could be resolved, in part, if we debated more openly the definition of health. We should not abandon modern preventive medicine, but we should undertake a brutally honest assessment of its proper purview. In particular, given our training and expertise, we health care professionals are no more competent to treat social distress than other citizens. We cannot fix everything (though we do some things marvelously well), nor can our patients — no matter how intelligent or attentive — prevent all disease and death. We may be trying to do too much and thus diluting an awareness and application of what we can do well. If we redefine health, I hope we can discover a definition that does not include a medical or social mandate to control people’s behavior for the sake of their mortal bodies; this would seem to me particularly compelling in a nation founded on the belief that one should not legislate behavior even for the sake of the immortal soul.”

    • Chris FOM says:

      That came out of the New England Journal? Really? They’d NEVER write something like that today.

    • Michel Accad says:

      Faith Fitzgerald had the audacity of enjoying a smoke… Tobacco addiction is in the category of preventable diseases that Dr. Rich talks about (like obesity, but unlike alcoholism, which enjoys a status as a genetic disorder and will not be subject to ostracism).

  3. FWM says:

    “In contrast to the Jews of Nazi Germany, one does not have to sew a Star of David to their jackets to know which individuals are wrecking the culture.”

    Don’t stumble into weakening your strong argument.

    Reductio ad Hitlerum:

    Just thought you’d want to be hip to this and all of us guys who spend too many hours reading on the internet.


  4. To some extent, I agree that it is your duty to maintain good health. But I just hope society does not get too narrow-minded and lump the genetically obese together with those who cannot be bothered to maintain their wellness and castigate all of them to no ends. It should still be a case-to-case basis, shouldn’t it?

    And I was enlightened about the list of now considered preventable diseases. But seriously, it’s not like it is common to check what trouble your genes could bring you in the future so you could prevent all that needs to be prevented. Yeah it would be common sense to avoid sweets if one or both of your parents are diabetic. But suppose two generations back your family was all healthy but suddenly you get that recessive gene and you suffer from maturity onset diabetes? What then? Anyway, sorry if I’m not making sense but the healthcare situation just frustrates me sometimes.

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