Life, Liberty and the Pursuit of Health and Happiness
How does healthcare fit into our fundamental rights of “Life, Liberty and the Pursuit of Happiness”? At a minimum, these include the right not to be murdered, imprisoned or enslaved, but does it also include the basic necessities for life, such as clean water, food, and shelter? What about indoor plumbing, electricity, heat, air-conditioning, and clothing? What about medical care? Do we only have the right to emergency services, or should we have access to all types of medical care, including preventative screenings, treatment for chronic diseases, and even anti-aging therapies to lengthen life? If, one day, we find a way to prolong life indefinitely, would all citizens have the right to immortality?
Liberty and the Pursuit of Happiness are intertwined since we all have different definitions of happiness and should be free to pursue our own unique path. Some people derive happiness from healthy pursuits, such as exercise; however, many people equate happiness with hedonism. When I have recommended smoking or alcohol cessation or dietary restrictions, many a patient has protested “But that’s my only source of happiness!” I find it interesting how many of the pleasures that we pursue ultimately lead to increased morbidity and mortality. In fact, both Liberty and the Pursuit of Happiness are inversely related to health, and thus, to Life.
The Pursuit of Happiness often equates to the pursuit of money, which often means sacrificing time with loved ones and time for rest, exercise, and home-cooked healthy meals in order to work longer hours, which leads to increased levels of stress and declining health. For individuals working low-income jobs, sacrificing one’s health to make money is necessary for survival. The Pursuit of Happiness, especially in the field of medicine, often forces women to delay childbearing until after completing one’s education and establishing one’s career path. This can lead to an increased risk of pregnancy complications due to advanced maternal age and/or decreased fertility with the need for expensive and potential risky fertility treatments. The Pursuit of Happiness may include aesthetic and cosmetic procedures and surgeries despite possible complications. In fact, these treatments may be seen as necessary for achieving one’s career goals since studies show that people believe that attractive individuals are more intelligent, competent and trustworthy.
Despite spending more on healthcare than other developed nations, our outcomes are among the worst. 88% of deaths in the US are due to lifestyle-induced chronic diseases. A combination of sedentary lifestyle, poor diet, stress, and use of alcohol, tobacco and other substances leads to heart disease, cancer, diabetes, strokes, lung disease and liver disease. These chronic diseases also increase the risk of death from infectious diseases such as COVID-19. Additionally, use of alcohol and other substances increases the risk of accidental death. Our healthcare system is primarily reactive, treating these chronic conditions without addressing the underlying causes, which is very costly and ineffective. A proactive approach would save both money and lives, but how would we accomplish this goal? We already know which behaviors are harmful for our health, but we choose to engage in them anyway.
If our true goal is to improve the health and longevity of Americans, it would require sacrificing both Liberty and the Pursuit of Happiness. One could imagine a Brave New World where freedom would be restricted with the goal of optimizing physical and mental health. In this dystopia, reproduction would be regulated and controlled with elimination of family structure in order to prevent domestic violence and child abuse. All immunizations would be required, and there would be strict isolation protocols to eliminate any transfer of infectious diseases. There would be no access to processed foods or other addictive substances, including alcohol and tobacco. A specific diet and exercise regimen would be required. Personal vehicles would be eliminated in favor of mass transit in order to prevent car accidents. Guns would be eliminated to prevent homicide and suicide. All dangerous activities would be restricted or eliminated, including, but not limited to, swimming, trampolines, and contact sports. These measures would drastically reduce morbidity and mortality, lower healthcare costs, and increase longevity, but I cannot imagine that anyone would wish to live in such a society.
How can we maintain our freedoms while promoting and rewarding healthy behaviors while discouraging the unhealthy ones? The majority of tax dollars currently subsidize companies that worsen rather than improve health, which includes health insurance companies. Rather than restricting freedoms or paying for reactive healthcare, why not subsidize healthy behaviors and dissuade unhealthy ones by imposing taxes on these items. For example, the easiest and most affordable way to feed one’s family is with processed foods. It takes extra time and money to eat healthy. If whole foods were subsidized the way processed foods are, and processed foods were heavily taxed, the healthiest choices would also become the most affordable.
I don’t anticipate any current or future government prioritizing citizen well-being over corporate profits, so let’s use our freedom to pursue small healthy changes and the happiness that comes from relationships, a sense of purpose, and incremental improvements in physical and mental health. If you’re looking for a place to start, consider Direct Primary Care. Having a personal primary care physician who works directly for you, instead of for the government and the insurance companies, is the best way to be proactive about your health and to live a long and happy life.
what a great article and discussion! Thank you so much for always providing such valuable insights!