One of the things we hear about all the time in healthcare is the financial burden of disease. Stay healthy so you’re not a burden.  People shouldn’t be obese or they’ll be a burden on the healthcare system with comorbidities like diabetes, etc etc.  Industries have blossomed overnight from society being told, stay healthy so you’re not a burden.  While I agree with the idea of being healthy – who can argue with that? – there is something underlying this line of thought that’s a little disturbing.

There becomes an “us” and “them” mentality.  Insurance companies already deny healthcare to people who do not live up to their standards.  For example, I spoke to a patient who was unable to get a liver transplant because insurance would not cover it.  Why?  Because he was an alcoholic.  This is an extreme case. However, I can eventually see (as the insurance companies run amok) the same reasoning applying to people with chronic conditions, such as obesity or fibromyalgia – or old age.  Medicare payments don’t cover health costs for the elderly, and supplemental insurance can be fantastically expensive. Will we reach the point of becoming a pay-as-you-go society for people who fall into a chronic condition category – if you can afford healthcare you can have it?

In looking at the financial burden on the healthcare system for fibromyalgia patients, I was surprised to find out that the greatest financial burden in fibromyalgia is from indirect costs, not healthcare system costs.  These are employment-related: losses in productivity, reduced work hours, absenteeism, disability payments, unemployment payments, and early retirement (see Skaer et al).  In addition, indirect costs to patients themselves are related to non-healthcare setting care expenses, people being paid to help with household and personal care, people coming to help but not being paid.  Obviously, putting 2% to 4.7% of the population back on its feet would significantly reduce these costs.

In the meantime, I watch commercials for medications and vitamins and supplements that promise everything but immortality (except in the quiet auctioneer voice at the end when death is threatened) which play off everyone’s fears of being useless and a burden and listen to the outcry against people who are a “burden” on society and just hope.  Hope for what? I’m not sure.