OP-ED

Healthcare: Right or Responsibility?

Steven schimpffDuring the presidential debates, Tom Brokow asked, “Is healthcare a right, a privilege or a responsibility?”The candidates did not answer the question, but now would be a good time for Congress and the Obama Administration to balance the rights being offered as part of reform with corresponding responsibilities.

We are the only developed country that does not assure all of its citizens basic medical care insurance access – shame on us. We spend more per capita for medical care than any other developed country yet our outcomes are not the best – shame on us. We mostly use price controls to try to slow rapidly escalating costs. They not only don’t work but leave patients with less than adequate care and huge bureaucratic frustrations – not logical. All too many individuals find that they are denied coverage because of a preexisting condition when they move from one job to another or find themselves unemployed – unacceptable. As a population we have all too many adverse behaviors such obesity, lack of exercise and smoking that are leading to expensive, lifelong chronic illnesses like diabetes and heart failure – killing ourselves. And primary care physicians find that they do not have time to offer good preventive care nor care coordination to those with chronic illnesses because insurance does not pay for these essential activities, thereby resulting in more visits to specialists, more expensive prescriptions when life style changes could have been effective, more procedures and tests – all of which lead to higher total costs of care.

Howard County, Maryland has instituted a program called Healthy Howard that offers the uninsured access to primary care for a minimal fee along with specialist care given pro-bono and hospital care for no charge. But in return, each patient works with a health coach to develop a set of goals for the year such as weight control, smoking cessation, exercise enhancement or stress reduction. Patients also are expected to receive appropriate vaccines and obtain basic screening such as checks for high blood pressure. The health coach assists the patient to overcome barriers to success such as helping to find a free smoking cessation program or an inexpensive gym. Patients have been pleased with the program and responded well to the responsibility element. It is a model balancing rights with responsibilities that is worth emulating.

Congress is rightly seeking to assure all of access to care regardless of ability to pay. It is not inappropriate for the tax payer to expect the individual in return to lead a reasonably healthy lifestyle as a means to not only maintain and improve health but to lessen the cost of care? Congress also plans to ban the practice of insurers excluding individuals with predisposing conditions. A reasonable expectation [responsibility] in return is that everyone participates in insurance so as to keep the risk pool large and the costs down. In another pairing of rights with responsibilities, commercial insurers and Medicare should be able to incent patients to hold down costs with premium reductions for those who do have an appropriate weight, do exercise, do not smoke, do get their vaccinations and do have screenings done.

Primary care physicians should be able to have a reasonable income without a huge patient load nor the necessity of short visit times but in return the insurer/payer should be able to expect excellent preventive services and good coordination of the care of those patients with chronic illnesses. In this model, both doctor and insurer each have their rights and each their responsibilities, resulting in better care, healthier patients and reduced total costs to the system. Government, and therefore the taxpayer, in accepting the responsibility of universal coverage for those who cannot afford it should have the right in return of a reasonably healthy lifestyle by those covered. The result is better health with lower costs over the long term.

This combination of rights and responsibilities can assure that everyone has access to care and incentives to better health. Yet, it will reduce expenditures through improved quality and eliminate many of the current frustrations with the “system.” It satisfies the legitimate arguments of those who insist that medical care is a right with the equally important argument that we all have to accept a meaningful level of responsibility for our health and its costs.

Dr Schimpff, who blogs at http://medicalmegatrends.blogspot.com, is the retired Chief Executive Officer of the University of Maryland Medical Center. He is a consultant to the United States Army on mechanisms to interdigitate high technology into improved patient safety in the “operating room of the future.” In 2007, Dr. Schimpff authored “The Future of Medicine”, a book focusing on genomics, technology, imaging, stem cells, and the future of the OR and information management. Learn more about The Future of Medicine book and podcast at http://www.medicalmegatrends.com.

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vetrap 3m bandaging tapepure lipokiramatalishaharchon41ExhaustedMD Recent comment authors
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kiramatalishah
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kiramatalishah

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Nate
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Nate

lol, peter do you even read what you post?
“And what U.S. hospital would let someone in with no health insurance?”
Um that would be only ever hospital in the country seeing as how its a federal law.
“It’s hard to argue with someone when all they have to bolster their position is misinformation.”
This he actually is right about, how ironic it follows a factual error and preceds further misinformation.

Nate
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Nate

hum Peter sounds like someone doesn’t have an argument so they try dismissing my points. If you had keep quit and not said anything then you would have let it gone, instead you claim I am misinformed then fail to counter even a single point. I bet your the type that says not to offen anyone right before you offend them. Or Your not one to gosspit right before you do?

Peter
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Peter

“And this flood of tales about Canadians coming south for needed treatment, waiting lists, shortness of modern diagnostic equipment, delayed surgery, unavailability of certain medications, these are contrived of whole cloth by “right wing” wack-a-doodles?”
YES!
http://new-canadian.blogspot.com/2009/06/are-canadians-flocking-to-us-for-health.html
http://content.healthaffairs.org/cgi/content/full/21/3/19
http://www.cbsnews.com/stories/2006/10/18/health/webmd/main2104425.shtml

Peter
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Peter

Nate, you are so intentionally misinformed I won’t even attempt to discuss this with you.

archon41
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archon41

The long and short of it is that the well-insured know they are getting better and more timely care than their Canadian counterparts. Cold, hard, uncaring, selfish, greedy bastards–just like the Kulaks.

Nate
Guest
Nate

Healthcare in canada has long waiting list, rationed care by dictate, and caps on consumption. Not that these things are always bad but you can’t honestly compare the cost of such a system to the cost of a system that allows you to walk in and have an appointment two days later. Our system also allows people to make more of their own decisions and try treatments other systems won’t allow. Again not saying this is good but that freedom comes at a cost. Medicaid is proof we can provide that type of system at cost equal to what other… Read more »

Margalit Gur-Arie
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Margalit Gur-Arie

Nate, why is Medicare just “so so” compared to private plans (disregarding the fraud issues)? ExhaustedMD, I believe most people agree in principle that everybody dies sooner or later and most people would even agree that in many circumstances sooner is preferable. Most people also agree that eating right and exercising is the right thing to do. The problem, as usual is the execution. Agreeing in principle and agreeing that my grandpa, or my baby, must die today are very different things. Agreeing that my grandpa has to die today, while the grandpa in the next bed can go to… Read more »

ExhaustedMD
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ExhaustedMD

You know what people are afraid to say, much less admit to themselves more often than not? People die, and sometimes they die sooner than we, as involved others in such an individual’s life, want to experience, as much I am sure the dying individual wants to face. The biggest problem in this health care mess is we keep some people alive longer than they should live. There, I will take the risk, and guts, to put this out here in this debate. So, when ALL the involved parties to health care changes are ready to accept this basic premise,… Read more »

archon41
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archon41

The bottom line is that nursing home funding, in Canada, is largely left to the individual provinces with spotty, and often deplorable results. I am pleased to see, however, that they seem to be making some progress on home visitation by those acutely in need of care.
And this flood of tales about Canadians coming south for needed treatment, waiting lists, shortness of modern diagnostic equipment, delayed surgery, unavailability of certain medications, these are contrived of whole cloth by “right wing” wack-a-doodles?

Peter
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Peter

“Canadian health care is maybe slightly better then our Medicaid.”
Explain how?
“The same people “advocating” for less expensive healthcare are the same people that don’t pay for their healthcare now.”
Why would they be advocating for less cost for what they don’t pay for, unless they’d like to pay for it but can’t afford to. Are companies struggling to keep coverage for their employees and want less expensive not paying for their healthcare. My neighbor, whose company policy premiums went up 43% this year, is advocating for less cost, he’s paying for it. Maybe a liberal hate line will bolster your argument.

Nate
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Nate

apples and oranges Peter. Canadian health care is maybe slightly better then our Medicaid. Have you compared Medicaid spending to Canada? They aren’t far off. American Private Insurance is heads and shoulders better then Canadian healthcare and cost more. Finally we have our most expensive plan, Medicare which is so so but cost an arm and a leg, about a foot and wrist of which is fraud and waste. If we all wanted Medicaid we would be price comprarable right away, 80%+ of us prefer what we have though. The same people “advocating” for less expensive healthcare are the same… Read more »

Peter
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Peter

archon41, you mean this: http://www.cbc.ca/news/background/nursing-homes/ Here is a Canadian report on elder care across the country which deals with those care facilities under the federal health act and those not, which would be provincially regulated. http://www.acewh.dal.ca/eng/reports/The%20Status%20of%20Canadian%20Nursing%20Home%20Care.pdf And here is one about U.S. nursing homes: http://www.nccnhr.org/node/227 Seems the problems are about the same, funding, funding, funding. Were you referring to privately funded or publically funded, because I’ve seen less than standard care in publically funded private nursing homes in Canada and the same here? I’m not sure why you threw this out when long term elder care is a different issue… Read more »