If we are serious about reducing health care costs, government action is not necessary.
If we just stop smoking, moderate our drinking, exercise and eat right, we'll reduce the incidence of chronic disease and live longer without needing expensive medicines or other interventions.
Thus the most important battle taking place in health reform is what I call the compliance wars.
At the heart of the HITECH stimulus was the idea that, with more data, we can intervene earlier in a disease process and prevent sickness.
Sites like Google Health and Microsoft HealthVault are all about bringing this data to you in the form of a Personal Health Record (PHR), which is supposed to empower you to do the right thing. Insurers are working the same angle with programs like Kaiser Permanente's MyHealthManager program.
There are also specialty sites working on bits of the compliance puzzle. I now get regular e-mails from Fitlinxx, tracking my exercise program and telling me how many elephants I lifted this month and how many ice cream sundaes I burned off.
A second way to fight the compliance wars is with a stick. North Carolina plans to be the second state to raise the price of employees' health insurance if they smoke or they are overweight. It's part of their comprehensive wellness initiative.
Reporters have called this the "fat tax" but it's really a form of risk rating. Obese people have more medical problems, on average, than their normal-weighted kin. The same is true of smokers.
But the push back is instantaneous as seen here, when an in-state blogger mentioned it. (Pay careful attention to the comments.)
Both the carrots and the sticks are aimed at leading people to education. Which brings me to the third alternative, charisma. Most educators are not charismatic, and their lessons put us to sleep.
Few people educated us more on the difficulties of diet and weight than Oprah Winfrey and her yo-yo diets. The answer, she finally found, lay in moderation, not fads.
Celebrity-chef Jamie Oliver agrees, and has made healthy eating a crusade. His latest effort takes him to Huntington, West Virginia, where he hopes to teach the locals (the fattest in America according to one survey) that if you take pride in cooking your own food you can learn to eat right.
Oliver is a personal hero of mine, being both dyslexic and hyperactive. The new effort is based on a previous effort in Rotherham, England, and involves him turning a community center into a cooking school, using his celebrity to draw people in to learn simple recipes and techniques which, he says, can make anyone a home cook.
It also involves him going into school cafeterias and not only trying to improve the food there, but evangelize the kids into advocates of a good home-cooked meal.
It's going to take all these efforts, and more, to get America's waistlines in better order. My question is, which do you think will work best? Data, sticks, or charisma?
This post was originally published on Smartplanet.com