Many have been lauding the current economic recovery plan.
I, however, fear that if the impending health care plan shows as little scope as the economic plan, being equally little more than a band-aid for a deeper wound, it won’t be good. It’s debatable if printing more money, creating more American insolvency, will pull us out of the economic crisis. Yet, to propose a trillion dollar health care plan without addressing what really ails us is lunacy. The bottom line is that the same issues plaguing our economy plague our health care. Both are the forums in which our social issues play out. Our country isn’t at a crossroads because of its economic and health care crises. It is at a crossroads because of its greed, its entitlement, its worsening lack of personal accountability, and its immediate recourse to litigation – all of which play out in the economic and health care arenas. If we wish to make a true change in health care, then all of our decisions need to be guided by the desire to avoid letting people, all of us collectively, regress into their worst behavior.
Beginning with personal accountability, I’ll share an interesting thing I heard in training. A colleague and I were in the ICU treating patients, and he remarked, “Everyone’s here because of a vice.” He meant it in jest, but it gave me pause. From smoking to drug abuse and addiction, to excess eating and shirking exercise, certainly a significant percentage of those whom we treat are sick fully or partially by their own choices. That definitely isn’t to say they shouldn’t be treated, but where is the accountability, and even, the payback into the system? If one takes away all personal accountability, as American society has done, then we’re left with many who never help heal themselves. It might seem confusing to analyze from where the decline in personal accountability came, but it may be quite simple. It’s a perversion of the American ideals of democracy and rights. With democracy, the goal is to make everything easily accessible to everyone, and while this is good in theory many people are not ready for what they want. People feel responsible for that which they put in good effort to acquire. So much nowadays is given away carelessly, with no effort really required to obtain, that it is an easy atmosphere for irresponsibility. Additionally, over the years, the concept of personal rights, an extension stemming from our original, wonderful preservation of civil liberties, went from being perceived as a gift, an ideal to which civilized societies should aspire, to a due. Consequently, many tend to absolve themselves of responsibility for their wellbeing, through their entitlement.
We wouldn’t be able to be so entitled if there weren’t, nowadays, some semblance of a guarantee in life. In the last century, with the advent of progress in technology and medicine, the multitudes have begun to count on things ‘going right.’ People have come, by virtue of modern advancements, to expect a guaranteed outcome – indeed, ‘perfection’ more and more. When anything falls short of that, they feel betrayed, angry, and want justice and compensation. Many often forget their own responsibility in their outcomes, forget that fate often intervenes independent of desire, and forget that perfection may be a mirage. Entitlement, a byproduct of rights fueled by this false semblance of a guarantee in life, is rampant in American medicine.
There are some solutions for curbing our wayward tendencies. For starters, we should develop sensible laws. Tough love laws should help encourage self-sufficiency and getting back on one’s feet. Concurrent with this, laws which counter, or discourage systemic abuse are necessary. Laws with proactive contingencies are also helpful to create incentive. Next, to help us shift our perspective, we should set a new media standard. It’s dismaying how low the overall quality of our media has become, with how often the same angle to stories is repeated – we tend to try and be as complimentary to ourselves as we can, rather than objectively self-critical. We don’t like to hear that we’re irresponsible, entitled, greedy, or unaccepting. Yet, all of us need honest media – we collectively raise ourselves to the level we’re given, and if we’re given substandard, inaccurate information, that is what we use to make decisions. A concerted effort should be made to inform well – this could be informally agreed upon by the big media players or codified more formally. Third, there should be an even larger push for palliative care. Americans have strayed from recognizing decline and death, even though it occurs to us all, and are consequently often unable to realistically assess outcomes. People must be re-familiarized with a sensible concept of mortality, and should be given assistance with recognizing and dealing with their own decline, through outpatient and inpatient protocols. As a final point, along with recognizing the state of the patient, real tort reform needs to be enacted, not just caps on damages. Lawyers should not be able to advertise to ‘recruit’ lawsuits, frivolous cases should be penalized, and defendants should be able to counter-sue if the case is without merit.
Finally, regarding that last ill, greed, it plays out in medicine in an interesting way. I don’t feel that most physicians are greedy; in fact I feel the field, overall, is quite ethical. The issue of monetary appropriation comes up mainly on the ‘opposite’ side in duly compensating physicians and their affiliates for their work. Physicians, as with all members of service industries – teachers, nurses, firefighters, police, and paramedics, for example, – should be well compensated. Physicians have been targeted for what they earn, but one should want those striving to do the best they can and take good care of others to be well paid.
America currently has malaise. Spending more money on treatment, without rectifying the essential problem, our shunning of personal responsibility, our entitlement, our recourse to litigation, and our greed, will simply be a cosmetic change. America through its citizens is extraordinarily open to change, is courageous and resilient. We need to be open to rectifying our destructive behaviors, which erode the effective and efficient provision of our care, as good, cost-contained health care should be available and affordable for every individual without bankrupting businesses, health care facilities, or our nation. Good medicine is that which promotes longevity of quality, and we need that now, to avoid becoming sicker.
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