“National parks are the best idea we’ve ever had. Absolutely American, absolutely democratic, they reflect us at our best and not at our worst.” -Wallace Stegner

I returned to the world of mobile phones and internet connectivity. I learned many things on a two-week excursion through the national parks, including something about health care in America. First, Canyonlands is a lesser-known, ad-free park, but it’s on par with the Grand Canyon and Yosemite in terms of scenery, with some great hikes. Second, don’t drive your Prius on back roads in Wyoming in the snow, but that’s another story. Finally, stepping away from my coastal and parochial vision of the United States may provide some insights into the future of American healthcare.

I saw three things on my trip to the west:

1) Obesity has become the new norm for Americans, at least for those who stay in hotels in national parks.
2) Smoking has really declined among Americans and is no longer welcome in most places.
3) Medical and surgical subspecialty care is increasingly available, even in rural areas.

The obesity problem was both shocking and terrifying. The incidence of overweight and obese people we ran into, visiting national parks and stopping at roadside restaurants, was staggering. The incidence was at least 40% and affected all age groups. The television vision of the United States does not reflect this truly profound and fundamental change in the nature of the people of our country and their expected health problems. It’s easy to pontificate on the impact of obesity in America, but seeing it in the field reinforces the impossible task facing our medical establishment and the regrettable responses from the government and Obamacare. Based on what I’ve seen, the impacts will be much worse than most projections. Diabetes and its complications will sink our healthcare system.

On a more optimistic note, I was surprised by how many smokers I saw and how marginalized they have become. Compared to my last visit to Wyoming many years ago, the number of people who smoke has dropped dramatically. Plus, I saw the new California archetype of the harried smoker, huddled outside in the rain to get a cigarette, in Casper of all places. I think the message that smoking is bad has reached much of the country and can have long-term health benefits.

Finally, I saw outpatient Lasik surgery clinics in Moab Utah, plastic surgeons in Ralston Wyoming, and cancer centers in Grand Junction Colorado. Previously, these smaller cities would have required people to travel many miles to obtain such services. High-level specialty care has become widely available, which is good. It will be interesting what happens with these services when the payments for these procedures are reduced.

Although I am not optimistic about our health system, the beauty of the national park system gives me a personal reason to stay healthy.