And the very last line of the article tells us that our health care costs the most of those in the study.  So we have OK outcomes but at a huge cost.  From my years in disability management I saw employees refuse to follow health care providers direction in relation to life style related conditions because we have an enabling system that rewards (or fixes) chronic conditions during acute phases.  I have seen people literally eating themselves to disability--like blowing their retinas, kidneys and ugly foot ulcers due to out of control type II diabetes--a condition which is sometimes reversible if patient follows doctors orders.  Our system is clogged with these folks--dialysis units have increased 300% over the last decade..  And dialysis patients are getting progressively younger.  The local dialysis unit goes to overtime everyday (but that's another story) Yet those of us who look after ourselves are caught in the queue when we need help.