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Correction to This Article
The My Time column in the Feb. 21 Health section incorrectly included firearms accidents among the leading causes of unintentional injuries.
Needed: Policy With Room for Accidents

By Abigail Trafford
Tuesday, February 21, 2006

The headlines continue about Dick Cheney's senior shooting party in Texas when the 65-year-old vice president aimed at a quail and shot his 78-year-old hunting companion instead. "One of the worst days of my life," a somber Cheney said four days later. "No more than a hunting accident," was how the local sheriff's office explained this friendly-fire incident.

Accidents are a major cause of disability and the fifth leading cause of death in the United States. About 110,000 people die in what health officials call "unintentional injuries" every year, according to the National Center for Health Statistics, most from traffic accidents, firearm injuries, falls and poisonings.

Accidents are bolts of fate. In a split second, everything changes. A car crashes into a tree, a gun goes off, a foot slips off a ladder. Gun accidents among people over 65 are rare compared with teenagers and young adults. Falls are more common. Each year, more than 200,000 older Americans fall and fracture a hip. Half never regain full function.

It is fortunate that at this point, Cheney's friend Harry Whittington is expected to recover from his wounds. And it would be fortunate if the vice president and his macho colleagues would learn from this hunting accident.

The most important lesson is that unintentional events play a significant role in health and can change a person's destiny. Yet the Bush agenda focuses on the power of individuals to control events in their destiny.

Whether it is saving for retirement, going on a diet or choosing a prescription drug plan, Bush policies are based on the twin pillars of personal responsibility and personal choice.The message is simple: Ask not what your country can do for you, but what you can do for yourself. But this doesn't work as a policy for all.

The Bush plan for health savings accounts and plans with high deductibles and co-pays favors people who are rich and healthy and have the option of not going to the doctor. They penalize those who are injured or sick and don't have much choice about seeking medical care.

The resort to rugged individualism is not all bad. Exhortations to exercise daily, eat moderately, wear seat belts and not to smoke are just common sense. But common sense is not an infrastructure for an aging population.

What's missing is a reliable safety net for those struck by events beyond their control -- or for those who are not able to pass the smart-consumer test. Perhaps that's why 45 million Americans have no health coverage and medical bills are a leading cause of personal bankruptcy. There's a public empathy gap. As a society, we don't seem to care.

The problem with a narrow focus on personal choice and responsibility is that it spreads the illusion that each of us can control our medical destiny. This is health hubris. To be sure, we can influence our health status by minimizing risks of injury and illness. But Cheney's accident brings us back to reality: People will get injured and sick even if they are careful and competent . . . even if they floss and jog and follow all the common-sense rules for a long, healthy life.

When an accident occurs or an illness develops, there's often a subtle blame game to assign fault: The pedestrian struck by a car was talking on a cell phone. The woman who slipped and fell had too many scatter rugs. The man who had a heart attack was overweight.

In the Cheney shooting, blame was first assigned to the victim: Harry Whittington hadn't announced his presence; he was in the wrong place. But Cheney set the record straight: "It was not Harry's fault," Cheney said. "I'm the guy who pulled the trigger and shot my friend."

Researchers know that there are usually multiple factors in an accident or disease. Some are preventable, but many are not. Once they occur, the individuals whose lives have been indelibly altered should get empathy and support from public policies, rather than censure and a pep talk about consumer choice.

Certainly, a woman doesn't choose to break her hip. A driver doesn't choose to hit a pedestrian -- nor does that pedestrian choose to put himself in danger. Cheney didn't choose to spray his friend with birdshot. His hunting companion didn't choose to get shot.

Maybe some public good will come out of this. Cheney's shooting accident has exposed the arrogance of health hubris and brought some humility to high places. The vice president could help change the rhetoric on aging and health in a way that balances common-sense principles of personal responsibility with common-empathy principles of public responsibility. ยท

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