Thursday, October 08, 2009

Convergence of 3 Core Healthcare Reform Issues: American values, personal responsibility, and pragmatic solutions

In the past few weeks, there's been a wonderful convergence of discussions focused on core issues underlying our country's healthcare reform debates; these issues are: American values, personal responsibility, and pragmatic solutions for a sustainable healthcare system.

For example, in the past two weeks, the Hasting Center posted the following blogs:
And the Health Affairs blog posted this: American Values And Health Reform

What's most exciting is that these issues go to very heart of who we are as a society, what we truly consider important as individuals, our level of spirituality, our degree of empathy and compassion, and our ability to think rationally/sensibly about the present and future. I've been writing extensively about such topics on this blog for several years; following are some links and summaries:
  • Personal Responsibility: A Thorny Issue in Healthcare Transformation – Explains why there's so much to consider when judging healthcare reform policies in terms of promoting personal responsibility.

  • Criteria for a Sustainable Health System – Presents 4 goals that any government healthcare reform proposals ought to focus on achieving i.e., promoting greater Self-Discipline, Personal Responsibility, Empathy and Compassion for the least advantaged (social responsibility), and Public Accountability (transparency). And offers 8 objectives that relate to those achieving those goals, i.e., Balance Investment & Spending, Balance Savings & Borrowing, Balance Conservation & Consumption, Balance Endowments & Entitlements, Connect Ends & Means (resource availability), Connect Should/Must Dos & Can Dos (priorities), Preserve Security/Protection, and Preserve Rights/Freedoms (opportunity and liberty).

  • A Principled and Pragmatic Approach to Healthcare Reform – Discusses two related issues:

    (1) How principled strategies for healthcare reform should be guided by empathy ("putting yourself in others' shoes" to understand what they are going through) and compassion (caring what others are going through and doing what we reasonably can do to help those in distress).

    (2) How a pragmatic strategy ought to find fair and effective ways to pay for the tactics aimed at realizing the two main objectives of a principled strategy: (a) providing universal coverage and (b) continually improving care effectiveness and efficiency leading to ever-better and more affordable approaches to care. Explains how this is made difficult by our society's tendency to focus on short-sighted, quick-fix solutions that are short on empathy and compassion for the public good, and also by our culture's failure to promote self discipline and personal responsibility & accountability. And it points to the need for substantial governmental reform aimed at minimizing lobbyists' influence, quid pro quo favors to party benefactors, operational inefficiencies, etc.

  • How to Reform Healthcare Sensibly: Focus on Two Clear Goals and Low-Cost, High-Quality Care In America: A Reply – Discusses how the focus of the current healthcare reform debate is out of balance, since (a) issues of money and insurance are by far the main focus, (b) issues of quality and knowledge are a minor focus, and (c) issues of empathy and compassion are mostly out of focus. Explains how focusing on all these issues in a more balanced way is absolutely essential for creating a sustainable, high value system in which everyone: (a) has access to excellent affordable healthcare, (b) gets the knowledge and guidance needed to make informed decisions and take responsible action, and (c) is incentivized to "do the right thing." That is, healthcare reform MUST FAIL UNLESS we balance (a) economic strategies that focus primarily on cost-control with (b) strategies aimed at filling the knowledge gap. As the article discussed, likely consequences of this failure include reduced care quality and productivity, as well as provider resistance.

  • Healthcare Reform's Most Important Issue: How to Make it a High-Value System – Discusses why a deep, rational debate about universal insurance versus single payer systems ought to be balanced by focusing on an equally (if not more) important core issue, i.e., how to dramatically increase cost-effectiveness (value to the consumer).

  • Empathy, Taxes, Personal Responsibility, and Healthcare Reform and Empathy, Taxes, Personal Responsibility, and Healthcare Reform – A Timely Debate (part 1) and (part 2) – Discusses how, from a psychological perspective, there is a lack of empathy (i.e., the ability to put oneself in the shoes of another) reflected by the fact that fortunate people with plenty of money or a secure job with an excellent health plan do not want to pay more taxes nor to risk changing the coverage they believe benefits them; even if such changes may benefit many others who are suffering. Includes a contentious debate I had with two people working in the insurance industry.

  • Healthcare Reform: Where to Focus? – Explains why Robert J. Samuelson misinterprets healthcare statistics in a Washington Post article, and why he is erroneous in his conclusions that (a) controlling cost is the central problem, (b) healthcare for the poor in our country is actually quite good, and (c) we cannot afford to view healthcare as a "right" that demands universal insurance for every American.

  • Aligning the Ought-To's with the Can-Do's – Argues that we had better focus on answering the questions: What OUGHT TO BE done to guarantee everyone has access to affordable, high-quality healthcare? and What CAN BE done, realistically, to make that happen? And then, wherever there is a misalignment between these Ought To's and the Can Be's (i.e., when we can't do what we ought to be doing), we'd be wise to ask ourselves: WHAT'S PREVENTING US and HOW CAN WE overcome those obstacles? I then explain why, when it comes to healthcare (as well as other domestic issues and even foreign policy) answering these questions isn't easy because it requires that we stop deceiving ourselves, and start critically and objectively evaluating the values, priorities, goals, and underlying beliefs of our culture.

  • The Whole-Person Integrated-Care (WPIC) Wellness Solution – The first of a series of posts that describes four types of people, with different character traits, who require different approaches to wellness due their different thoughts, emotions, behaviors, knowledge & understanding, and coping strategies.

  • Are you worthy of health insurance and high-value care? and Worthiness, Socialized Medicine, and Individual Responsibility – Examines and debates the questions: Who is worthy of having adequate health insurance and high-value (safe, cost-effective) care; what makes them deserving? And who, on the other hand, is unworthy; what makes them undeserving?

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