Healthy Skepticism

I spend a Sunday stretched out on the couch watching TV, drinking a few beers, and scarfing down some nachos, all the while thinking how great it will be once the state's universal health insurance plan goes into effect next July. Finally, we're all going to be healthy.

Of course, no such thing is going to happen. And while my self-portrait of indolence may be overdrawn, it's far less an exaggeration than some of the hopes for Massachusetts' new law. Granted, requiring health insurance makes for a good piece of economic justice. But will it actually make people healthier? Probably not.

Part of the reason for that may surprise you. We've all heard the scare statistics - 46.6 million Americans lack health insurance - that lead us to assume that those many millions aren't getting the health care they need. That conclusion, at least when it comes to Massachusetts, isn't true. According to the state's Department of Public Health, virtually everyone already has access to health care. Admittedly, it's a clumsy and far-too-expensive system. Paying customers subsidize free-care pools. Those without a regular doctor show up in emergency rooms. And the cost-reimbursed nature of the system means few have an incentive to reduce costs.

Yet, solve all that, and we're still not much healthier. And the reason, to be blunt, is that, when it comes to our own health - or lack of it - we're really to blame.

Partly, we're just dumb. Perhaps the best-selling cold medication in the country is Airborne, a fizzy concoction of "seven herbal extracts" whose principal claim to efficacy is that it was invented by a teacher. It's hard to imagine any other field of endeavor where lack of expertise would be deemed a positive. Few would argue a rocket ship would fly truer if a lawyer designed it, for instance. But when it comes to medicine, the skills of a teacher (second grade at that) apparently trump those of doctors and researchers.

We may laugh at the gullible public from a century ago that was taken in by the hucksters of patent medicines, but, in truth, little has changed. We are still remarkably credulous. Thus, millions buy homeopathic medicines, go to acupuncturists for anything that bothers them, believe in aromatherapy, take megadoses of vitamins, and routinely undergo chelation therapy. In most cases and for most uses, each of these therapies is largely scientific nonsense whose reputation for effectiveness is a combination of questionable anecdotes and wishful thinking - the well-known placebo effect.

Meanwhile, as we desperately seek health in quacky nostrums, most of us fail to do the things that actually can prevent morbidity and mortality. The list is well known. Smoking is the leading cause of death in the United States. Obesity is close behind. Those two, combined with poor nutrition and excessive drinking, account for a stunning 40 percent of all deaths (and a vast proportion of related illnesses) in the United States, according to the Centers for Disease Control and Prevention. Diseases and infections such as HIV/AIDS (about 1.2 million cases) and chlamydia (nearly a million cases) are entirely preventable. Injuries from motor vehicles - the leading cause of death of those aged 15 to 44 - could be drastically reduced if more people simply drove sober and paid attention to the road.

The onus isn't entirely on us, of course. Some causes of illness and injury, such as an unclean environment or violence (homicide is the leading cause of death for African-Americans aged 10 to 24), are often best addressed by the public sector. And in some cases, we've been improving. Smoking and exposure to secondhand smoke, for example, are down in Massachusetts. Nevertheless, even as we abandon one bad behavior, it seems we latch on to another - the most notable of which is that we all are getting fatter.

The point of which is this: Healthcare is what happens when we get hurt or sick. Health, on the other hand, is largely under our own control - and right now, much of what we believe and how we behave is just foolish. The new universal health insurance law, as good as it is, won't change that at all.

Tom Keane, a Boston-based freelance writer, contributes regularly to the Globe Magazine. E-mail him at tomkeane@tomkeane.com.