2009 will certainly be recorded in history for many things, but included will be the beginning of a long term effort to make very tough health care decisions. Up until now we've been spending a great deal more money than our global economic competition and then only covered the middle class and wealthy with health care insurance. In the legislation pounded out in Congress in the waning months of 2009 they've extended health insurance coverage substantially and done some things to "bend the curve" of ever escalating health care costs but where do we have to go from this very modest beginning?

Clearly cost will always the big stumbling block. We've been spending about $1 of every $6 of GDP for health care, and other countries we compete with for global business about half of that. The recent legislation will pressure and help the health care industry to become more effective and efficient, and that will certainly help, but these incremental solutions will always merely push the wolf from the door temporarily, and he'll be back again and again a few years down the road.

We keep hoping for the long sought miracle cure for cancer and heart disease to save us but, it's been a long time coming, and when and if it does come, will it save us from these enormous health care costs? Maybe not. One of the things that's becoming apparent is that living longer by defeating one manner of death, doesn't necessarily lower health care costs. A magic bullet cure for cancer would certainly be a welcome development for us individually but collectively such a miracle would end up increasing the world population that is already at fundamental global limits, increasing the number of people requiring geriatric care, and producing costs for the treatment of whatever diseases ultimately do cause the death of those who benefited from the cure for cancer. We certainly should keep up the search for a cure, but we shouldn't expect it to be, in addition, a cure for our economic ills.

Midst all of this gloom however there is available to us a miracle cure. One that doesn't require the help of government, or of the health care delivery or insurance industries, one that requires no science breakthroughs, or expensive technology to implement.The down side of it? It gives us nobody to blame for failure.

We can individually choose to take better care of ourselves. Exercise a lot more. Limit drinking and stop smoking. Loose weight and eat healthier. Wear helmets and seat belts. We'd live longer and better, we'd be more productive in business, we'd require less health care during our lives, more of us would be able to take care of ourselves in the waning years rather than requiring so much help. All good. For all of us.

We like to blame others for what's dysfunctional in our lives. Those politicians. The Wall St tycoons who rob us blind. The insurance companies. The extravagant hospitals who charge $100 for an aspirin. The special interest lobbyist who buy the politicians . Everybody is at fault but us. However, we are the key to these problems. These attempts by government and business to keep us healthy are only allowing us to live more dysfunctional lives and getting away with it.

The big question is, what tools are available to inspire a change in our culture? We all pay for our unhealthy lifestyles, but our tradition is that those lifestyle choices are individual. Does that leave us as a country helpless to take advantage of this complete cure that is readily available for the fiscal impact of health care costs that drags our economy down?

Interesting questions.