I-Care, and so should you

It's not Obamacare or Romneycare that we need. It's I-Care. It's all about us caring. If I care, you should care, too, and we should all take steps together toward a national health insurance program that actually gets at the major public health problem.

Obama care has been given a green light by the Supreme Court, but the political debate rages on as to where it will lead us. We'll have a better idea in November as to where we are headed.

In the mean time, we have an obesity epidemic raging. Obesity is linked to heart disease, stroke, high blood pressure, diabetes, cancer and many other health problems. Recent studies have even suggested autism is linked to obesity in mothers.

Simply put, being too fat is a condition that underlies and contributes to a wide range of disorders.

How bad is the epidemic? One researcher at Weill Cornell Medical College recently suggested as many as 60 percent of Americans are obese. The problem is not getting any smaller. It's growing. And neither Obamacare nor Romneycare does anything significant to turn this epidemic around. That's why we need I-Care.

Obesity is measured in terms of Body Mass Index (BMI). BMI is a formula using weight and height to estimate body fat. It's not a perfect measurement because it can underestimate body fat of older adults and people with low muscle mass, and overestimate body fat for people who are muscular and fit. But it is a good general yardstick.

In I-Care, BMI would be important. I-Care would provide universal coverage, but there would be co-pays. Those co-pays would be designed to provide an incentive for people to care about themselves. Don't care if you have a BMI that labels you as obese? You are going to have a big co-pay. If you care about yourself, your co-pay will be small or nonexistent.

What this plan does is make people who are the problem pay more of the costs of national health care, while allowing those who make good decisions pay less. It's not fair to have people who exercise regularly, eat right and stay fit subsidizing people who just don't care.

I'm not talking about huge, budget-busting co-pays, either. But large enough to be a real incentive. Perhaps some people will just choose to pay. That would be their choice.

Smokers wouldn't get coverage unless they go into an anti-smoking program. Alcoholics and drug addicts wouldn't get coverage unless they get into rehabilitation and try to kick the habit.

So who controls the care and sets the co-pays? I envision a scale of co-pays related to BMI. The gatekeeper on care would be the primary care physician. Primary care docs already do, or should be, doing this with their patients now: suggesting diet and exercise routines that will improve patient health and help prevent illnesses.

This would turn health care upside down. Instead of concentrating on detecting and treating disease after it has occurred, which is the way medicine has traditionally operated, the emphasis would be on preventing disease in the first place. Hardly a novel idea, but one that has taken a back seat for too long.

What do you do with people of meager means, who can't afford co-pays? Waive them on the condition they follow their doctor's prescription. If they don't, then they don't care. We'll still have to care for them somehow, but it will probably be in emergency room settings as we do now.

Medical care costs are soaring. They are perhaps unsustainable, given the current economy. There are many reasons for costs going up, among which is the continual development of new medical procedures and equipment. I guess that's a good reason. But there's a bad reason, too. A lot of the increasing costs are simply being inflicted upon the system by a mass of people who just don't care.

Under I-Care, they'll have a wake-up call, and an incentive to care.

Bill Hauda is a bicyclist, veteran of some 50 marathons, including 13 in Boston; a former competitive triathlete; founder and first president of the Bicycle Federation of Wisconsin; currently a BFW board member; and former director of Wisconsin's two major cross-state bicycle tours, GRABAAWR and SAGBRAW.