I've written a few blogs about fixing health insurance, and so have most people in the world, it seems. Everyone has an opinion on how it can best be done, and there's starting to be a consensus among people, or rather, there are a couple of consensi, and one has more adherents than the other.

    The problem is that these solutions only fix health insurance. Now,health insurance certainly needs to be fixed. We need universal coverage. We need to control costs. These are very necessary if we are not going to bankrupt our country. However, guaranteeing care to everyone won't be very effective if we don't improve the care that's being given.

    There are several problems with the care that's given. There's a good blog by Dr. Frank Lipman about it. I don't agree 100% with everything he says, but you should read it, and encourage everyone you know to read it, because it does cover the main points.

    One thing he does not talk enough about is our personal responsibility. He mentions the idea of a health coach, and I think that's a good idea, but it will only work if people spend the time to learn what to talk to their coach about. This isn't a basketball coach we're talking about, watching each player for areas they can improve, and telling them to work harder or they'll kick them off the team. This is a doctor, who primarily knows what you tell him or her, and can only help you if you first help yourself.

    Also,if we are going to help improve the health of at-risk populations, we need to be serious about it. Poor people are more likely to get diabetes, and poor diet and lack of exercise are risk factors for this disease. Have you ever been to the grocery store and noticed that the mom with three kids who is paying with food stamps is buying a bunch of junk food, and not a lot of fresh fruits and vegetables? That's not because she doesn't care about her kids, or about her body. It's because calories from junk food are cheaper than calories from healthy food.

    If we want to put the brakes on diabetes among this demographic, we need to restructure food stamps so that it will only pay for healthier food (it already only pays for some items at the grocery store, and if food makers stood to lose part of their market if they couldn't show some redeeming quality to their food, perhaps the quality of the food would go up). We could reduce the amount of food stamps by a little, and put that increase on the non-food welfare payment for those who qualify. Then, if someone really wants a twinky (do people really like those, or do they only exist to be the butt of jokes?)they would have to find some actual money for it, but they could snack on veggie trays to their heart's content. And their hearts would certainly be contented, even if their taste buds craved something different.

    Are there problems with this plan? Certainly. We would have to carefully set the rules about what could and could not be purchased. Is ground beef too unhealthy for food stamps? What about ground chuck? Who gets to decide on what is or isn't allowable under the food stamp program? I think right now the rules are actually set by Congress, but this would need a governing body more responsive to changes in our understanding of the science of health and nutrition. Also, would it be better to have the rules set by the states? There are arguments for and against this idea.

    And this is just one aspect of healthy living, affecting just a part of the population. The discussion of how to fix health care will be much tougher than the one over how to fix health insurance, and it's not even really begun. It needs to begin soon, because without it,costs cannot be controlled, and better insurance will only help us buy more of an inferior product.