Toward a New American Century

An opinion column in today's WSJ by Michael Milken provided some interesting food for thought.  He begins by citing America's woes and the fear that this is the end of the American Century -- the time when we will lose our pre-eminence.  He then lists and explains six different opportunities for change, if America is willing to assume some personal responsibility -- one of these six opportunities certainly hits home for me.

The first he considers is housing -- stating that we've had it wrong -- non-recourse loans should have been money made available to small businesses rather than those buying homes.  "Ironically, a larger share of the population own homes in many other countries where borrowers don't have a mortgage-interest tax deduction and put up far more equity...In the long run, jobs support housing, not the other way around..."  That would have been quite a stimulus injection for small businesses.  The second opportunity are entitlements (though I guess you could argue that each of his remaining five points are entitlements!).  "Unrealistic promises of overly generous health and retirement benefits forced General Motors...into bankruptcy..." and parallels this to the government as an institution and our Social Security System and other social entitlements.

He goes on to address education, immigration and energy in a similar fashion.  The opportunity that resonated with me was his discussion of healthcare.  "But we should also demand more of ourselves.  The Milken Institute's 2007 study "an Unhealthy America" notes that 70% of health costs are related to lifestyle."  As an internist, I would certainly say this is true.  I take care of patients everyday that heavily utilize the healthcare system as a direct result of obesity, tobacco use, excessive alcohol use and a sedentary lifestyle, either in isolation or in striking combinations.  While I try in earnest to counsel my patients about a healthy lifestyle, it often seems to fall on deaf ears -- and in reality, these are things that people know anyway right?  They just choose not to eat healthy or exercise in any way, and at the point where they are heavily utilizing the system, they often perceive that it is too late to change.  I'm not sure of the solution -- how do we motivate people to assume personal responsibility for their own health?  It seems like such a basic concept.  Perhaps it is taxation -- some feel it would be unfair to levy higher taxes on "fast foods" -- is that because access to fast foods is a right just as access to healthcare (regardless the reason for your illness)  is perceived as a right?  In decreasing the cost of healthcare, I would argue that prevention of illness at the individual level is a must.

Milken, Michael.  "Toward a New American Century".  Wall Street Journal, October 7, 2010.