At the time of this writing, President Obama’s health care plan is on its way to becoming the number one hottest topic nationwide. Historically, the great enemy in politics is insincerity. This single entity is one of the greatest challenges facing the Obama administration in the healthcare debates. My purpose in this piece is not to judge politics or politicians’ motives but to bring a more fundamental and understated health issue out into the open.

Gladys, a patient of Dr. Siegel¹, had suffered chronic intestinal inflammation for about fifty years. The family who took care of her looked sicker than she did, since a family member had to wait on her twenty-four hours a day. Even when they hired a nurse to care for her, Gladys would awaken the family and let the nurse sleep. Over and over she developed severe pains while at home which mysteriously disappeared each time she was admitted to the hospital.

I present this example not to underestimate the gravity of genuine diseases, but rather to expose psychological underpinnings of the common sick role. Since physical illness usually brings sympathy from friends and relatives, it can be a way of gaining attention, love, and nurturing. It can become a patient’s only way of relating to the world; the only control one has over life. The broad implication of this example is not trivial to the current healthcare debates facing the Obama administration.

My colleague, F. Walden Navarro, has spent over twenty years exploring the impacts of person-centered construct on all kinds of health and health care issues. As per an on-line discussion with him, he stated that in his research, he witnessed ‘time after time that care-seeking propensities are just as important as disease prevalence in generating health care costs.” He reported that “even controlling for perceived health status, care-seeking propensities lead to higher demand of many health care services, independent of perceived health state or health risk factor levels. The costs associated with this care-seeking is unwarranted and unnecessary, yet medical providers are only too happy to open the door to those types which display avid care-seeking, and health plans such as Medicaid and Medicare keep paying the claims. One health plan study examined three years of claims data across the path types. The spread in total median claims dollars exceeded $4000 per member per year. That level of cost difference is right on par with the medical costs associated with morbid obesity. When care seeking propensities are combined with morbid obesity, the costs double. After controlling for perceived health status and self-reported health risk prevalence, the impact of care seeking is equivalent to the power of the SAT to predict college grades.

In plain language it boils down to this: current health policy does not invest in policies that promote sound health behaviors. Quite the contrary, it robs those who take responsibility for their health (e.g., those who do not smoke or drink, but eat healthy and exercise) and gives it to those who don’t. Health legislators did not establish effective incentives or deterrents for good or bad health behavior; nor do they show any signs of investing or supporting scientific inquiries despite the fact that health disciplines are sorely in need of an assessment in these areas.

We should not be quick to buy into claims that health officials are responsible for their deliberate lack of support of preventive medicine on the basis of their unwarranted support of pharmaceutical giants or tobacco companies. On the other hand, we should not be so naive as to dismiss these officials entirely. The truth of the matter is that neither the health officials nor those who continue to adopt unhealthy behaviors have any real incentive to make changes to reverse the current trend. Health officials, just like other policy makers, are just as much social units as are the ruled, and are distinguished only by the fact that they give voice to the State Doctrine. They do not need to be personalities capable of judgment, but thoroughgoing specialists who are unusable outside their business interest. State health policies decide what shall be thought and studied. Therefore, change must come from within; those who take responsibility for their health should stand their ground and say no for paying for those who don’t. Unless Obama’s goals for health care reform include these overlooked health psychological dynamics, we stand helpless before this problem.

REFERENCES
1. Siegel , B.S. (1988). Love, Medicine & Miracles (pp.107-111). New York: Harper & Row Publishers.