This post appears on the Hastings Center’s Values and Health Reform Connection, a new group blog on American values and why they matter in health reform.
Values come from the gut, not the mind, and the gut is not a sophisticated thinker about the nuances of alternative policy options.
—Jim Sabin, MD Essay: Responsibility
I’m going to do something “radical” here in the spirit of Dr. Sabin’s opening quote – and speak from my gut on the topic of responsibility.
In my opinion, it’s human nature to shirk responsibility, and our current society is a great facilitator of that natural urge. The more wealthy and technologically comfortable we become, the fewer responsibilities we have (in terms of securing basic needs), and the more empowered we are to indulge our inner narcissism. Until we accept that we all have this selfish tendency, we’ll continue to point at others and engage in a blame game that keeps us all very much in the dark about what’s really going on.
How does our lack of responsibility manifest itself in healthcare? Many of us don’t care for our bodies as we know we should – smoking, drug abuse, overeating, under exercising are rampant. We blame everyone but ourselves for our lifestyle choices while 75% of our healthcare dollars are spent treating chronic disease that’s 80% preventable. In a way that’s the end of the story.
However, we are also a very wealthy nation – with the capability of offering good healthcare benefits to all. We don’t do it partly because we don’t feel responsible enough for others (every man for himself) and partly because we know that most of the costs are preventable, and that makes us angry – why should we pay for others’ irresponsibility?
We have to find a way to meet in the middle – people need to show a good faith effort in improving their lifestyle choices, and be incentivized to do so. The wealthy should pitch in more to help with the 20% of medical costs that are unavoidable. We should continue to look for ways to make treatments more targeted and efficient, to reduce waste in the system (including defensive medicine – which requires tort reform), and to facilitate healthy lifestyle choices at all levels of society. We don’t need a new and expensive government-run healthcare system to achieve this – the power to turn this around lies within each of us. But we won’t be inspired to take on that challenge if our unhealthy choices continue to have no apparent consequences for us.
If we dislike the “evil health insurance and pharmaceutical companies” then there’s one good way to keep them out of our lives – don’t need them! It’s like reducing our dependency on foreign oil – natural gas, wind energy, and electric cars can all contribute to decreasing our utilization of oil. So too can walking, healthy eating, and physical labor reduce our dependency on drugs and health insurance.
All I can say is, there needs to be a national “come to Jesus” moment. We need to look at how we’ve all failed to be responsible (whether we didn’t care for our bodies, or didn’t help those in need as much as we could have, or both) and make a national commitment to change. Instead of shouting at one another in town halls, we should be marching around the country encouraging each other to get fit. It will take a long term commitment, sustained effort, and determination. But isn’t that the ultimate American spirit? We need to rally ourselves to our own cause – bring on the community organizers who can inspire locals to reduce their calorie intake and increase their walking/exercise quotient. If we don’t want healthcare to be rationed, then there’s only one way around it: take up the banner of personal responsibility and keep ourselves as fit as possible. As President Obama says, “no excuses.”
We don’t necessarily need nuanced policy ideas, we need to go with our guts – or perhaps get rid of our guts – to fix healthcare.
“Fired Up! Ready to Go! Yes we can!”
If we apply those rallying cries to slimming our waistlines and kicking our bad habits – the rest of healthcare reform might actually take care of itself.