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? Note that this is the first post of a four-part series.
I contend that the only way to improve healthcare quality and control costs—and sustain these benefits well into the future—is for our highest priority to focus on obtaining and using clinical knowledge wisely by rewarding the use of evolving evidence-based knowledge to support decisions about how best to prevent health problems and treat them cost-effectively. Such solutions would overcome devastating effect of today’s healthcare “knowledge void” and broken economic models.
Sadly, this is not the case. While our society considers certain people worthy of having health insurance, we consider no one worthy of receiving high-value care. So, why don't we deserve it?
I believe there are many reasons for this. One is our failure to invest adequately on the science of evidence-based medicine and health information technology. Another is political pressure from those with a stake in maintaining the status quo because they gain financially from a low-value, error-prone healthcare system in which ignorance and misaligned incentives dominate. Our system considers them worthy of high income and profits, while the healthcare consumer suffers. This is a model for disaster.
I suggest the solution start with a shift in the way we think of “worthiness.”
First, we ought to consider all Americans and other legal residents as being worthy of adequate health insurance coverage. This is the realm of universal healthcare and there are different models for paying for such care, which should be examined and compared. Unfortunately, the idea of universal healthcare runs counter to the American Capitalist model and its “free market” principle. So, the very idea of universal healthcare requires national debate about the goodness of our economic system and how our society determines human worth and deservingness.
Since people’s addictions, emotional problems, poor lifestyle choices, etc. worsen their health and increase costs, we ought to change the things in our society that promote these kinds of problems, rather than simply dismissing these people as unworthy. We could, for example, do such things as:
Second, we should consider all Americans and other legal residents as being worthy of high-value (safe, effective and efficient) care. This means transforming our current healthcare system into one that focuses on eliminating waste, errors, over-treatment, under-treatment, inappropriate treatment, ineffective interventions, dangerous medications, etc. It also means doing a better job with prevention and other aspects of well-care.
In conclusion, let me say that I strongly believe our country could afford to deliver high-value care to all our citizens and others (including undocumented workers and their families) if we replaced:
• Waste & inefficiency, ineffectiveness, greed, ignorance, secrecy and misaligned incentives, which benefit an “economically worthy” few
… with …
• Efficient, safe & effective, economical, scientific knowledge-based, transparent, and appropriately incentivized wellcare and sickcare for all.
Anything less is lunacy!
Click here for part 2.