I can’t help but think of George Costanza’s shouty argument in Seinfeld, “we’re living in a society!” when I think about health care reform.  Today, I was lucky enough to get a seat at a talk by Atul Gawande on health care disparities, and then in the afternoon, I got to listen to lecture on childhood obesity.  During both talks, the issue of individual freedoms came up in both the truly individual sense, and in the larger, health policy-and-mangement sense.

First, health care reform: one of the first thing I hear people complain about (patients’ parents, even some nurses I work with, conversations on the T) is that they don’t want to pay for other people’s ill health.

Second, childhood obesity: there’s an ad that’s aired in Texas that frames the obesity issue as a consumer rights issue - don’t take away our right to eat ice cream and drink soda.

The absurdity of both arguments - which are really one argument - makes me want to knock some heads in.  The idea that individual health is the individual’s responsibility is only partially true.  People feel that sick folks should pay more for their health insurance because they didn’t “protect” themselves and it’s partially their fault that they got sick.  Sure, maybe a little bit; maybe that guy down the street’s obesity and associated heart disease and diabetes-related vascular disease could have been avoided if he took more responsibility for exercise and eating well.  But we all know it’s a lot more complicated than that.  We all know that there are (1) genetic predispositions among certain populations towards diabetes/hypertension/obesity, (2) it’s friggin’ hard to lose weight even if you have the motivation and the means to do so, (3) we live in a society that is pushing more soda, juice, and pies in larger portions than ever before.  We are a society that likes to pretend that your disease is your own business, and that your health exists in a vacuum of personal choices or occasionally, genetic mishaps.  But come on, people.  We know that this is simply not true.

Okay, I need to get off my soapbox now, but bottom line - I don’t mind paying a little more to close the gap on health disparities knowing how complicated “being healthy” truly is, and I wouldn’t mind the government shutting vending machines out of schools and implementing healthier school lunches, because come on, we live in a society, folks.