A nation of hypochondriacs

March 27, 2010 11:35 PM

Has the American health care nonsystem made Americans more neurotic about their health?

I'd especially appreciate comparisons if you have traveled extensively between the United States and other nations or recently moved into / out of the United States.

My impression, as an American who has not lived elsewhere, is that the high price and often inaccessibility of health care, the model of health care as a privilege, has promoted and been reinforced by a libertarian can-do attitude towards health. If you eat right, exercise, stay out of the sun, don't smoke, etc., you will never get sick. Many doctors promote this attitude in order to scare patients into better health behaviors. The popular health press is also responsible for promoting this attitude.

Are Americans more upset about getting sick and more likely to be neurotic as a result?

This might also explain the underlying causes of the behavior of the tea partiers. They mostly seem to be seniors on Medicare, but perhaps they fear that the creation of other entitlements will cut into Medicare. They have internalized the libertarian attitude and think that other people who are sick don't deserve aid. But I'm also interested in your impressions of "normal" people.

posted by bad grammar to health & fitness (26 answers total)

Not sure where you're getting the libertarian thing. You are clearly inferring that many libertarians are conservatives, but this is not the case. Libertarians believe in practically no government at all and have many beliefs that are totally at odds with those of conservatives. Like they think cocaine and all other drugs should be legal, etc. No offense, but don't get irrational here and start thinking that the 60% of the country who opposed the health care bill are all crazy lunatics.

I do think you make a great point about the media--I definitely think the media is to blame for a neurotic attitude, especially about crap like staying out of the sun. Personally, I think this is because the media is all about money like all businesses, but the public thinks they're totally unbiased and not driven by profit, so the media can scare everyone, which we all read, and doing so creates a pervasive fear in the public. I find it extremely unethical. With the swine flu, I had no clue whether it was a serious threat or just some big overblown crap like SARS and the West Nile Virus and all that other crap.

But realize that the media does this with a lot of things--like the tea party--every day it's in the papers and on the news, but the reality is that it just doesn't matter. You're talking about a couple hundred people or however many out of over 100 million Conservatives. Same thing with Sarah Palin. She has nothing to with anything--she doesn't even hold public office. Why does the media focus on her and not, say, a Republican Senator who actually matters? Because people hate Palin and want to read about her doing something stupid. Do you really think Palin issued instructions on her Facebook page for people to assassinate Democratic Congressmen? Do you really think someone threw a rock through dude's office on the 30th floor of a skyrise in Cincinnati?
posted by stevenstevo at 12:30 AM on March 28, 2010

I also meant to say I think you bring up an interesting question about smoking? I am not sure why Americans have always smoked more than everyone else. I'm not sure there is a definitive answer--likely a combination of a number of factors.

It may not even be the case that Americans smoke more than other countries. Problem is it's difficult to measure health care costs and especially health care costs attributable to smoking. For one thing, all countries have different health care systems. Take Switzerland and England--while they have a "universal" health care system, it's not as good as everyone thinks--they cap total spending at a certain number, so there are more out-of-pocket expenses which are conveniently ignored. This makes our health care costs look higher than theirs when it may not be. In Switzerland for example, they spend only 11% of GDP on health care--in the US, it's 17%, which is what has led everyone to believe we our health care system is more expensive. However, in Switzerland, their out-of-pocket expenses equal about 31%. In the US, out-of-pocket expenses are only 12%.

Also, in the US, one of the reasons our health care costs have increased over the last 10-20 years is because all the best technological innovations in the medical field have come out of the US. It's the same thing for drugs--no other country compares. Thing is, these developments have led to better and earlier diagnosis of some problems. So we are catching diseases like cancer which we may not have 20 years ago. This makes costs seem higher, but it's a good thing--better to diagnose and treat someone than have their disease or what have you go undetected. In addition, other countries get to reap the benefits of these developments and drugs while the costs are all borne by US companies.

It's really a pretty complex issue. I do think Americans have always smoked more than Europeans. It could be simply a geographical thing. We have the right climate for tobacco in some parts of the country. Pretty sure Canadians have always smoked a ton too, right behind us.
posted by stevenstevo at 12:49 AM on March 28, 2010

I can't really speak to the health anxiety levels of other countries, but I do think the cost of medical care in the US causes a lot of anxiety. It is the second leading cause of bankruptcies (behind divorce). And medical social workers often advise couples to split up in cases of long term illnesses (Alzheimer's), to protect assets for the healthy partner. Anyone who has seen it, is frightened.

I think that the drug company advertisement may add to health anxiety (a really weird thing, and not common in other industrialized countries.). But the main thing that makes it seem that the US is so obsessed, might be as simple as the aging population.

Until recently Europeans, especially the French and Italians, smoked more than Norlth Americans, and it was more acceptable. Only recently have the French required no smoking sections of Restaurants.

It is very, very strange that fear of hurting medicare pushes some people to the teabaggers, but it does seem to be the case. So, the support the party that has voted against Medicare for fifty years, and left it totally unfunded in there shadow budget? Well, that is the message the republacan'ts are putting out, and logic isn't the wingnuts best thing.
posted by Some1 at 1:19 AM on March 28, 2010 [1 favorite]

I'm an expat now and have been in the past. It's a hard thing to judge - my work situations have been less pressure-cooker than in the States, and my social circles are different overseas - but it seems like folks at home are less likely to take sick days and stuff. In the States, I would definitely just work from home when I was sick. And I think there is a dread of the doctor that keeps people from going as soon as they should, though I'm not sure if that is unique to the US.

w/r/t the smoking thing, by the way, the US isn't anywhere near tops in smoking. According to this chart, we're #39 in the world...
posted by clipperton at 1:28 AM on March 28, 2010 [1 favorite]

I think most people have the "it's not going to happen to me" attitude. And since it's not going to happen to them, then screw anyone else who gets sick because "that's not my problem and I'm not going to pay for it!" I think that this attitude also contributes to many people having the exact opposite of neurotic when it comes to health. They feel invincible so they eat what they want, watch TV too much, smoke, drink, etc.

Another problem is that I think certain insurance plan structures encourage people to avoid going to the doctor all together -- take plans with deductibles for example. This doesn't mean they try to be healthier to avoid the doctor, it just means they shrug off colds/flu/infections they could go seek treatment for, but don't because they don't want to pay $100+ out of pocket for an office visit.
posted by thorny at 1:32 AM on March 28, 2010 [1 favorite]

If you eat right, exercise, stay out of the sun, don't smoke, etc., you will never get sick. Many doctors promote this attitude in order to scare patients into better health behaviors

...that doesn't seem to make any sense. If they're making a profit off you getting sick, why would they want to prevent it? I live in the UK where health care is pretty much 'free' (obviously its not actually free, its paid for by taxes) and the attitude is very much the same here, but it makes sense - the less people get sick the less money from the budget goes towards healthcare.
I would have thought people would be more interested in taking care of their health and doing whatever they could to prevent illness if it was going to personally cost them money.
posted by missmagenta at 1:34 AM on March 28, 2010 [1 favorite]

Having lived in various parts of the US, Europe, and Asia, I'd answer 'no'. My experience is that every culture worries about different things (e.g. Western Europeans are much more concerned about avoiding genetically modified crops, while this is a virtual non-issue is the USA), but Americans as a whole aren't notably more pro-active or "can do" about maintaining their health than other cultures.

Having said that, the stereotype of the health-obsessed American upper-middle class -- with its organic-food-and-aerobics ethos -- may indeed be more 'neurotic' about pro-active health than the world average, to the extent the stereotype is true; however, it's doubtful that health-care access concerns are motivating that economically privileged demographic.

It's perverse that those with the most precarious access to health care aren't especially careful about preserving their health, but that's been my observation nonetheless.
posted by Dimpy at 1:35 AM on March 28, 2010

This is a really interesting question. I'm currently living somewhere in Asia, a place increasingly renown for its medical tourism (which fact increasingly appalls me, the longer I'm here). After various unsatisfying visits to doctors at world-class clinics, I have slowly developed a hypothesis composed of one part "anecdata" and two parts generalization and speculation. Here's how it goes: As an American, my idea of what "healthy" feels like is far narrower than the idea of "healthy" as understood by (even the well-heeled) people of this nation. That is, my friend who is from here might have diarrhea for five days straight, but she does not consider herself to be sick, or even concerned enough to make a doctor's appointment. I, on the other hand, am off to the doctor on day four itself, where I DO seem neurotic, quite often, by virtue of the fact that I EXPECT for the doctor to take this seriously as something that requires his or her attention. Seriously, I am consistently surprised by how indifferent and dismissive the (highly recommended) docs here are with regard to symptoms that WOULD get taken seriously in an American doctor's office. And it is frustrating as hell to me -- particularly the time I had what turned out to be an ear infection, one that nobody took seriously for three weeks because I was up and on my feet and "not too feverish."

Maybe because American doctors have a serious financial incentive to run all sorts of "unnecessary" tests, things like ear infections GET CAUGHT EARLY. As a result, I think I know what perfect health feels like, in a way that a lot of my friends here don't. As a result, I have a very high standard for what "feeling healthy" actually feels like. And so, to answer your question: as one of the lucky Americans who has been insured most of her life, I think that the American health care system has made me neurotic in a GOOD way.

Footnote: Of course, privilege is key... it's far easier to stay healthy in America's well-maintained streets (amidst its well-maintained sewage systems, etc. etc.) than it is here. And an American without insurance has a totally different standard of health, as I learned shortly out of college, when, uninsured, I made a practice of avoiding the doctor until problems got truly pressing...
posted by artemisia at 2:04 AM on March 28, 2010 [1 favorite]

In Switzerland for example, they spend only 11% of GDP on health care--in the US, it's 17%, which is what has led everyone to believe we our health care system is more expensive. However, in Switzerland, their out-of-pocket expenses equal about 31%. In the US, out-of-pocket expenses are only 12%.

So in Switzerland they spend 42% of their GDP on healthcare + "out of pocket expenses"? That doesn't sound very plausible to me. Do you have some sort of evidence? What out of pocket expenses are you talking about? Drugs? Meals in hospitals?
posted by I_pity_the_fool at 2:57 AM on March 28, 2010 [2 favorites]

I would like to see where it's cited, for a fact, that "Americans..[are] more upset about getting sick and more likely to be neurotic as a result." I would also like to see where you get the notion that "The popular health press is also responsible for promoting this attitude." I am utterly, completely sick (HA no pun intended) of being referred to, me being an American, as ignorant, afraid, and hateful toward the poor.

You know what? Eating right, exercising, and not smoking is going to lead you to better health than laying on the couch, eating Burger King every day, and smoking a pack a day. It just is. If you (OP) are honestly in doubt as to what would cause an American doctor to inform his or her patients of those facts, then I think you should probably read something besides your TV screen. If you really think that "libertarians" are responsible for "inaccessible" and "high-priced" health care, than go to Wal-Mart. Yes, that bastion of evil free-market capitalism. They offer free prescriptions for a LOT of common maladies. (penicillin). FREE. If not free, it costs 4 dollars. Four dollars.

Now, I'm by no means trying to say that everyone in America has the same access to the same medical care. Here's what I am saying: For you to suggest that American doctors' telling their patients to quit smoking, eat something fresh besides fucking McDonalds and put down the video games is a "libertarian" plot to "scare" patients into better health is absolute bullshit. You call those Americans who are concerned about their health "neurotic?" Whatever, dude.
posted by lucky25 at 3:06 AM on March 28, 2010

UK - we're health paranoid as hell. Someone started a project to list all the things the Daily Mail claimed caused or cured cancer - and lasted four days because the Mail seems to have a cancer story every single day.

"Many doctors promote this attitude in order to scare patients into better health behaviors. "
What? I'm in medical school in the UK. It's an expectation that nearly all of us will join the NHS. Health promotion is a very important part of what we are taught. We lose marks in assessed mock consultations if we don't suggest stopping smoking to smokers.

I haven't been to the USA, but I have been following the healthcare debates. It's struck me that there are attitudinal differences between the UK and the US, but 'more paranoid about health' doesn't seem to be one of them.
posted by Coobeastie at 3:22 AM on March 28, 2010

My impression, as an American who has not lived elsewhere, is that the high price and often inaccessibility of health care, the model of health care as a privilege, has promoted and been reinforced by a libertarian can-do attitude towards health. If you eat right, exercise, stay out of the sun, don't smoke, etc., you will never get sick. Many doctors promote this attitude in order to scare patients into better health behaviors. The popular health press is also responsible for promoting this attitude.

Your impression seems thoroughly out of line with what is actually being said. The things you mention enhance your quality of life, as well as the likelihood that people will live healthy lives. I don't know a single doctor (and I work with a lot of them) who says that it's guaranteed to help you never get sick. That's contrary to, you know, the science of sickness.

The can-do attitude (eating right, exercising, avoiding known carcinogens and trying to maintain good mental health) isn't some kind of conspiracy; it's the optimal solution for the first-world when it comes to improving our aggregate health. That doesn't mean it applies to all people, it just applies as a whole. It's not some kind of conspiracy.
posted by Hiker at 5:20 AM on March 28, 2010

In Switzerland for example, they spend only 11% of GDP on health care--in the US, it's 17%, which is what has led everyone to believe we our health care system is more expensive. However, in Switzerland, their out-of-pocket expenses equal about 31%. In the US, out-of-pocket expenses are only 12%.

So in Switzerland they spend 42% of their GDP on healthcare + "out of pocket expenses"? That doesn't sound very plausible to me. Do you have some sort of evidence? What out of pocket expenses are you talking about? Drugs? Meals in hospitals?

I read this as "spend 11% of GDP on health care, but out-of-pocket expenses equal about 31% of their total health care expenses". If that's what it means (and I haven't done any fact checking, but it seems plausible that way), then the math breaks down as follows:

Switzerland:
HC - .31*HC = .11*GDP
HC = (.11/.69)*GDP = .16*GDP

US:
HC - .12*HC = .17*GDP
HC = (.17/.88)*GDP = 0.19*GDP

Result: US spends more of what we make than Switzerland (19 percent as opposed to 16 percent), but not as much more.
posted by anaelith at 5:57 AM on March 28, 2010

I am sorry that I used "libertarian" as a term, as it seems to have drawn a particular kind of response. I was hoping for a broader political spectrum of answers, less abstraction, and more personal observations like artemisia's above.
posted by bad grammar at 6:09 AM on March 28, 2010

Along the lines of this book, but with a focus on general health attitudes rather than the experiences of the sick.

I'm also interested whether more egalitarian societies than the United States foster a less anxious attitude towards one's health.
posted by bad grammar at 6:14 AM on March 28, 2010

I'd like to offer a different take one aspect of this, which may be out of left field.

Moreso than most places, the US is a celebrity driven culture. As many of them are younger, have their own trainers, nutritionists, etc. and don't often have real 9-5 jobs, the men have abs that one could bounce a quarter on, and the women have waists that one could almost wrap ones hands around. A personal fat content of 0% is the ultimate target. The Hollywood images become accepted at the ideal, and are seen everywhere - magazine covers, TV, the beach and gym.

Trying to get into what is considered good shape probably has to do more with trying to get into the zeitgeist, rather than any thoughts about the lack of medical care.

This response doesn't consider the class structure, celebrity medical options given play on Oprah (Jenny McCarthy for example), a medical system that barely considers preventive care, a distrust of anything government (public health), etc. but these are can't be ignored as factors.
posted by Chuckles McLaughy du Haha, the depressed clown at 8:52 AM on March 28, 2010

[few comments removed - please stick to the question and not ho does or does not have a right to bitch about anything, thanks.]
posted by jessamyn at 9:36 AM on March 28, 2010

A few things to note:

• The people shut out of the health care system are also shut out of the "eat right" culture. If your food choices are limited to fast foods/calorie swamp foods your BMI is likely to be higher. *

• If you eat right, exercise, stay out of the sun, don't smoke, etc., you will never get sick. I've never had a physician tell me this. The message is that I'm accountable for my choices. I can lower my chance of diabetes by keeping my weight in line. That's actually good for cost control and good for quality of life. You can make similar arguments about avoiding strokes, skin cancer, etc. It's disease avoidance versus disease management. For everyone that we can keep healthy, we've got a little bit more to spend on the people who are sick. (And if you've had aging parents, you know know many of us will eventually get to the point where we need some expensive medications and medical care.)

• What is the alternative? I want to be informed about choices I can make to have a healthy body and a good quality of life. There are enough diseases and injuries I can't avoid. Information about smoking, seat belts and SPF doesn't make me neurotic. I allows me to make informed choices.
posted by 26.2 at 10:11 AM on March 28, 2010

Actually as an Indian who moved to the US for graduate studies about three years ago, I would like to add an (anecdotal) data point in favor of the OP's hypothesis. I do feel that Americans are fed this message about eating right, staying out of the sun, taking the right supplements etc., much more so than even upper class Indians and perhaps people from other countries. I get the sense that people have the attitude that if you do all things right, you're absolutely certain of getting what you deserve in the end. This attitude goes some way towards explaining why Americans take so few sick days, observe so few national or religious holidays and also seem to think that sick people must have done something wrong to have gotten that way (well, I guess few Americans would tell a cancer patient that it's their fault they got cancer, but they do tend to behave that way when evaluating the risks of getting sick themselves). If you're not fat, don't smoke, get no more than one cold a year, then you're going to be just fine and don't really need proper healthcare. Even on Metafilter, I have seen people arguing along these lines in the healthcare threads. Reading the health sections of pretty much any magazine or newspaper will go a long way towards convincing you that Americans as a nation are obsessed with living longer and healthier than ever before. Which is not really such a bad thing, but can lead to unfortunate side effects, like nutritionism instead of just eating real food (cf. Michael Pollan).
posted by peacheater at 10:36 AM on March 28, 2010 [1 favorite]

The first thing that came to mind for me was marketing, specifically the marketing of over-the-counter drugs and then prescription drugs. Also, there's this chain of events: NEJM or JAMA report that studies have shown that X can help you live longer. Reuters or one of the other services pick it up, and it is in every single newscast/newspaper the next day, local or national. It becomes a topic of conversation and the meme spreads. Companies pick up on the buzz and go to town engineering processed foods that contain X. The marketing for the new food products lets you know that Hoppin' Toasty Bits are now infused with X, which helps prevent cancer. Mmmmm, Hoppin' Toasty Bits. CANCER! I am breathing in the cancer! Someone sneezed cancer on me! Must buy more HTB's!
posted by mattholomew at 10:55 AM on March 28, 2010

stevenstevo: This makes our health care costs look higher than theirs when it may not be. In Switzerland for example, they spend only 11% of GDP on health care--in the US, it's 17%, which is what has led everyone to believe we our health care system is more expensive. However, in Switzerland, their out-of-pocket expenses equal about 31%. In the US, out-of-pocket expenses are only 12%.

This is total nonsense. The cost of health care is not measured by out of pocket expenses. It is either total spending as a percent of GDP or spending per capita. Out of pocket expenses are simply a function of the variable deductibles of plans or whether your employer pays or you pay. The cost is there whether it comes directly out of your pocket, your employer's pocket, the insurance company's pocket or the government's pocket. Eventually it all comes out of your pocket and the U.S. has by far the most expensive health care in the world -- two or three times per capita compared to most developed countries with similar results.

stevenstevo: Also, in the US, one of the reasons our health care costs have increased over the last 10-20 years is because all the best technological innovations in the medical field have come out of the US. It's the same thing for drugs--no other country compares.

Five of the world's top seven pharmaceutical companies are in the UK, Switzerland and France.

You really should turn off the Glenn Beck show. It will make you stupid. And then you spread the stupid on the internets. Bad information is like a virus.
posted by JackFlash at 11:44 AM on March 28, 2010 [1 favorite]

Actually, I think the Swiss vs. USian math is 0.31 * 0.11 = 0.0341 vs. 0.12 * 0.17 = 0.0240. The implication is that the greater out-of-pocket costs borne by the insured lead to greater cost control, possibly by better health behaviors. There's an entire science to this and I won't delve into that.
posted by dhartung at 12:02 PM on March 28, 2010

The implication is that the greater out-of-pocket costs borne by the insured lead to greater cost control.

Except that you can't extrapolate from one data point. Switzerland just happens to have the highest out of pocket expense yet is second only to the U.S. in total health care spending. All of the other developed countries, for example, UK, Germany, France, Sweden, Australia, Japan, have lower out of pocket expenses than both the U.S. and Switzerland, and at the same time have much lower total health care spending. The theory is not supported by the data.
posted by JackFlash at 12:41 PM on March 28, 2010

I think the profit motive in US healthcare has promoted unrealistic expectations for health status in our culture. There's a "cure" for every ailment, and for a lot of things that are not exactly ailments, but normal discomforts of life. We all feel entitled to any measures available, as long as we call it "health care."

Nortin Hadler's books The Last Well Person: How to Stay Well Despite the Health-Care System and Worried Sick: A Prescription for Health in an Overtreated America are about our tendency to medicalize and overtreat the many manifestations of aging, and to screen and intervene just because we can, not because we should. Interview with the author (pdf).
posted by Snerd at 1:02 PM on March 28, 2010 [3 favorites]

If you eat right, exercise, stay out of the sun, don't smoke, etc., you will never get sick. Many doctors promote this attitude in order to scare patients into better health behaviors. The popular health press is also responsible for promoting this attitude.

This thesis is sort of advanced by Barbara Ehrenreich's new book on positive thinking, in which she claims that cancer support groups in the US relentlessly promote the idea that negative thinking makes people sick and positive thinking cures them.

They mostly seem to be seniors on Medicare, but perhaps they fear that the creation of other entitlements will cut into Medicare. They have internalized the libertarian attitude and think that other people who are sick don't deserve aid.

This is just people wanting to have their cake and eat it too (that is, wanting ample social services and low taxes). A number of authors would suggest that the American Dream ethos suggests why even the poor are often resistant to raising taxes on the rich (the poor believe that they could be rich some day, etc), and we've seen a lot of stupid rhetoric from people who are afraid "government health care" will destroy Medicare, etc.

You're also indirectly beating around a question which is really central to the debate over public health care: will health care be over-consumed if someone else pays for it, or is health care under-consumed if people have to pay for it out of pocket? You can Google around and find a lot about that.
posted by l33tpolicywonk at 2:05 PM on March 28, 2010

I'd say that a lot of Americans living with chronic conditions have tried getting relief by approaching U.S. medical doctors, or the "standard" health care system, somewhere along the line, and quickly realized that American doctors are first of all mandated reporters to the state, and secondly purchasers of large premium malpractice insurance policies which they must have to practice, and thirdly licencees of state medical boards which determine their fitness for and standards of practice, and fourth gatekeepers by license of access to modern pharma, and a very, very distant fifth (if even that place, in the metaphysical hierarchy of reasons people practice medicine), an educated individual concerned about the welfare of paying customers. God help you if you live in intractable pain in the U.S., because a doctor willing to prescribe opiates at realistic dosages, and deal with the side effects, is going to be harshly looked upon by the DEA and malpractice insurance policy writers; as a consequence, many U.S. doctors, by policy, routinely under-medicate chronic debilitating pain. Too, too bad for you if you have infections that aren't quickly controlled by a handful of prescription antibiotics; you're liable to be forced into a hospital, put in isolation, and ramped up to aggressive vancomycin, linezolid and daptomycin therapies within a few days, with bills running 4 figures or better per day of hospitalization. And for many Americans, the last 3 months of their lives consume more medical care dollars than their entire previous existence, with a drug hazed, and possibly very painful death the only outcome to the patient.

Moreover, some percentage of Americans have been harmed by doctors, and want no more of modern medicine, regardless of whether they sue for malpractice, or not. Of these, many continue to live with implanted medical devices, such as artificial joints or cadaver tissue transplants, of uncertain long term performance, simply because the alternatives offered by revision surgeries are little better, and come with new risks of their own.

You don't have to be a Luddite to be done, in your own life, with American medicine, even as you help others continue treatments and regular health maintenance screenings. And if you are one of those who is done with American medicine, and has secured for themselves multiple means of self-deliverance, it seems a terrible, pointed burden to be forced by a tax system to pay for the continued practice of those who have harmed you, when you'd rather die than ask of any of them, anything, for yourself, ever again.
posted by paulsc at 3:34 PM on March 29, 2010