SACRAMENTO, Calif. -- We've resolved to eat better, lace up the running shoes, shed a few pounds, quit smoking and lead healthier lives.
If we could keep our promises beyond the first weekend of the new year, perhaps our health care system wouldn't be as bloated as it is.
Indeed, some of the responsibility for health care costs sits squarely on the shoulders of consumers who make unhealthy choices – by supersizing meals, quenching thirst with sugar-laden sodas, filling lungs with tobacco and taking a less active role in maintaining their overall fitness.
"As important as health reform is, the real answer in reforming America's health care system is to empower individuals to make better choices about what we eat and how we live," said Daniel Zingale, a senior vice president at the California Endowment, a health foundation.
While debate remains in Congress over health care legislation, wellness advocates are hopeful that less controversial provisions promoting healthy living will remain in any bill that reaches the president's desk.
"As preventable illnesses and injuries are the most significant drivers of increasing health care costs," the Oakland-based Prevention Institute said in a letter to the White House, "it is essential that we reorient our health care system from an after-the-fact approach to one that focuses on keeping people healthy in the first place."
The House bill includes $34 billion for a public health investment fund, including $15.4 billion for prevention and wellness programs.
The Senate bill is less generous, providing $15 billion for a prevention and public health fund, some of which could be used for so-called community transformation grants to fund parks and urban trails and to promote access to nutrition.
The Senate bill also would establish a national council that takes a broad approach to drafting a health care strategy that integrates transportation, agriculture, education and employment policies. And it would adopt California's pioneering law requiring fast-food outlets and chain restaurants to provide nutrition information.
"This is the first time in recent history that community and government strategies will align to help support us in the resolutions we make on New Year's Day," said Larry Cohen, the Prevention Institute's executive director.
Wellness and prevention have been "totally lost in the discussion over the health care bill," Cohen said, "because it's … been recognized by both sides as being worthwhile."
Wellness programs spread
By 2017, U.S. health care could account for $4.3 trillion in annual spending, or a fifth of every dollar spent in the overall economy, according to the National Coalition on Health Care. Much of that could go to preventable conditions linked to obesity, smoking, diabetes and heart disease.
Indirect and direct costs of smoking are now $193 billion a year, about half spent on medical expenses, according to the U.S. Centers for Disease Control and Prevention.
In 2007, diabetes accounted for $116 billion. In 2009, heart disease was expected to cost the country $305 billion for care services, medication and lost productivity, according to the CDC.
Obesity costs the nation as much as $147 billion annually, according to a government study released in July.
In California, the national symbol for healthy living, one in every four people is now considered obese. In 1985, when the CDC began measuring the nation's expanding girth, 9 percent of the state's residents were classified as obese.
"Sugar-sweetened beverages are the single-biggest culprit in the obesity epidemic," said Harold Goldstein, executive director of the Davis-based California Center for Public Health Advocacy.
"The simplest thing people can do is drink water instead of soda. It would save everybody money in these hard economic times … and it would have a dramatic impact on the obesity epidemic."
For years, experts have preached healthy living to reduce the rates of chronic conditions.
To save on costs and boost productivity, employers and insurers over the years launched wellness programs to promote healthy habits.
The California Public Employees' Retirement System, the nation's second-largest purchaser of health care, has long promoted so-called wellness programs.
Last year, CalPERS posted the lowest increases for health premiums in 14 years, part of which it attributed to reduced use of health care services by its members.
"The effect of lifestyle decisions on health do matter in the overall control of health care costs," said Patrick Johnston, president of the California Association of Health Plans. "What works financially for the individual also works for health plans. … Lower health care costs mean health insurance coverage can be more affordable, and if insurance is more affordable, more people can be covered."
'A nation of sick care'
Ellen Wu, executive director of the Oakland-based California Pan-Ethnic Health Network, isn't about to let the health care industry off the hook.
"Our health care system shares some of the responsibility for our increasing health care costs," Wu said, noting that profit-minded industries make it difficult for people to access routine health care. "It's a shared responsibility. We cannot expect individuals to be healthier without an environment that promotes health. … I think you have to give people the opportunity to live healthy."
Communities need access to healthy food and safe public parks in which to exercise, she said.
"We are a nation of sick care. We don't do health care," she said. "Because we do sick care, that's reflected in how we set everything up."
Gaining health insurance will allow those who are now uninsured access to doctors for regular checkups and routine care that in the long run could relieve the need for expensive emergency room visits.
Even so, people will have to take a more active role in maintaining good health, Wu and others acknowledge.
Healthier lifestyles could reduce health care spending, but on a personal level folks will reap the benefits, too, in the form of fewer trips to the physician – meaning fewer co-pays and other out-of-pocket expenses – and less time away from work, said Dr. Lisa Liu, a physician at Kaiser Permanente's Elk Grove medical offices.
"There is a linkage there between health care utilization and cost. As individuals, there are ramifications associated with bad habits. People need to take personal accountability for their health," she said.
Setting goals is a good start, said Liu.
But "making them and keeping them are totally different. The challenge is picking the right resolution," she said. "Simply saying 'I'm going to lose weight,' is just a wish and not an active plan. …
"New Year's resolutions need to be reasonable and achievable."