Steve Case


With passage of health-care reform legislation imminent, this is a significant moment. Many have fought for decades to bring about meaningful change on this issue. Whether or not you agree with the legislation, there is no denying that mountains have been moved. But let's also be honest in acknowledging that while these changes are a start, the real work to reform health care is just beginning.

The battle over the past year wasn't about health-care reform; it was primarily about insurance reform -- how we pay for care.

They say in medicine that the real challenge is to get the diagnosis right. If there's too much focus on the cure before it's clear what the problem is, the "solution" won't stick. And that is exactly what happened with the health-care debate we just witnessed.

As a nation we bypassed the diagnosis stage and quickly focused on addressing problems related to the insurance system. But those are secondary, not primary, issues. A core issue is that our nation has too many people with too many diseases that are debilitating and costly. We have focused our attention on triage -- solving the immediate problems when people get sick -- rather than on getting people healthy, to reduce future problems.

The truth is, our country doesn't really have a health-care system. We have a sick-care system. Our system isn't primarily designed to keep us healthy; it's organized to get us well when we get sick.

Take a hard look at our real underlying disease: the lifestyle choices we make every day that lead to more sickness and thus more cost. This vicious circle is poised to continue unless we craft a system that encourages and rewards health, rather than accepting a system that finds it easier to deal with us after we have become sick.


Now, this nation does a pretty good (albeit, costly) job of getting people well when they get sick. But we're missing the larger question: What can we do to keep people from getting sick in the first place? The area that requires the greatest focus relates to chronic diseases.

The number of people with diabetes is nearly 24 million. The National Bureau of Economic Research estimates that obesity rates will top 40 percent by 2020, and annual related medical costs have already reached $147 billion. By some estimates, chronic diseases account for more than 70 percent of the $2 trillion spent on medical care in the United States each year.

Chronic diseases result from a number of factors, including heredity. But for most people they are largely caused by unhealthy behaviors such as poor nutrition, lack of exercise, smoking and other largely preventable lifestyle choices. Amid the debate about health-care reform, why is there so little discussion of the role each of us can play to improve our health and reduce our nation's financial burden?

Americans can't let the health-care debate happen only around conference tables in Washington. We need to have discussions with our families around our kitchen tables. We are part of the problem and should be part of the solution. Helping pay the costs of healing sick people may be an important role for government, but doing what we can to avoid getting sick must be a commitment each of us makes to ourselves, our families and our communities.

This is not about who pays for what. It's not even really about disease. It's about the decisions each of us make every day. We can collectively benefit our nation by making smarter choices that don't burden others with the costs of our sick care.

For most of us, the jargon of the debate over health care isn't what's important. While we let our elected officials figure out how to pay for the increased access to care, why doesn't each of us focus on staying out of the system as much as we can? That means making a few simple changes that, if embraced, can improve our health and save our country a lot of money. Good starts would be: Eat less food and make smarter choices about what to consume. Move your body more. Don't smoke. These are all simple lifestyle choices that over time can add up to significant change and create a positive long-term impact on your health and our nation's health-care system.

The writer, co-founder of America Online and chairman of the Case Foundation, is chairman and chief executive of Revolution, an umbrella corporation that supports companies with innovative business models.