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Doctors and insurance agents are in the front lines of the health-care battles spilling from Washington across the nation this month. With politicians blaming them for the fix we're in, they've hunkered down, nursing their grievances and looking to fight back.
President Barack Obama and the Democrats should be on guard. But so, too, should ordinary Americans.
Some doctors and insurance agents are saying what the politicians won't say - we're doing a lousy job of taking care of our own health, even as we demand more care at less cost.
Patrick Skinner, a McKinney, Texas, health insurance underwriter, said Texans make demanding patients who want the latest medications and the best technologies - or else.
Dr. William Walton, a Dallas family physician and past president of the Dallas County Medical Society, agreed.
"Every single medical professional is thinking a patient may attack them in court," Walton said. "I see patients all the time who think a fancy test is indicated. They say, 'It doesn't cost me anything. Insurance pays for it.'
"We all know if they had to pay that $3,000, they probably wouldn't do the test. They'd take the aspirin and see if the pain goes away."
Last month, 10 communities from around the country came to Washington to explain how their health care networks managed to achieve good-quality results while keeping costs down. Most mentioned the importance of culture in achieving their goals, and some said that their communities don't have demanding patients.
Dr. Nancy Nielson, past president of the American Medical Association, envied the results but warned that other places would be different.
"What are we going to do with the rest of the country? It just ain't that way," she said.
Patient responsibility is one difference.
"We have a health crisis, not a health care crisis. We have an unhealthy population," said Jim Greenwood, chief executive of Concentra Inc., a nationwide occupational health and outpatient clinic company based in Addison, Texas.
Greenwood cites obesity data recently aired by the U.S. Centers for Disease Control and Prevention in Atlanta. In 1986, not one of the 50 states had an obesity rate of 15 percent or more among adults. In 2006, more than 20 percent of adults in 46 states, including Texas, were obese. Last year, Colorado was the only state left with an obesity rate below 20 percent.
Obesity often leads to diabetes and heart and kidney problems. It adds $147 billion a year to the nation's health care bill, according to the CDC.
Much of the attention on this issue deals with the roles that food and restaurant companies play in contributing to the nation's weight gain.
Dr. Tom Fogarty, Concentra's chief medical officer, looks instead to the patient.
"As a public, we've made lifestyle decisions that are not in our interest regarding exercise, obesity and smoking," he said.
Of the three, he said he's most concerned about Americans' lack of exercise.
Greenwood was blunt about the consequences.
"To compete in the global economy, we've got to wake up," he said.
He said companies should become much more involved in their employees' health.
"Americans are much more apt to eat right and exercise if somebody asks them to do it," he said.
Jim Landers is a columnist for The Dallas Morning News. Readers may write to him at the Dallas Morning News, Communications Center, Dallas, Texas 75265.