Monday, September 21, 2009
American values and health care
I read a good post from the New York Times about Health Care Reform and 'American Values' and it got me a thinkin' ... just what are American Values when it comes to health care? Usually I get a little anxious when I see "American Values" in a sentence, because what usually follows is something about rugged individuality, pulling oneself up by bootstraps, getting the damn government out of our lives and those damn immigrants and welfare mothers who won't work and want to live off others.
But I have listened to about ten thousand patients over the past 25 years, and I have a good idea of what these Americans want for health care. They are the silent majority ... the people who work, study, raise their kids and seldom call into a radio talk show. They don't have time to go to town hall meetings and shout slogans.
They range from age 17 to 101 and most of them are middle class. They come in all races ... Asian, black, white, Pacific Islander and mixes of all.
Some are wealthy enough to have multiple homes and private planes.
Some are uninsured and watch their health care spending very closely. Most were thrilled to get Medicare and I've never heard a complaint from a Medicare patient.
Here is my list of what these Americans think about health care:
--They do agree that everyone should be covered for basic health care and would pay higher taxes if they could believe that there would not be fraud and waste. (The recent banking meltdown has destroyed all confidence that government can regulate or be independent from special interests.)
--They want choice of physicians and hospitals.
--They are sick of insurance companies and all feel like they have been screwed in one way or another. They are shocked at how little insurance companies pay toward the doctor visit and the way those fees are discounted.
--They are technocentric and want tests, imaging, referrals and think "more is better" when it comes to health care. They think tests are cures. Because of the perverse incentives, the "more is better" philosophy benefits doctors and hospitals, but not necessarily patients.
--They fear losing insurance if they have it.
--They are confused about the current reform debate and mostly fear losing whatever coverage they now have, because they know how impossible it is to get by without any coverage at all.
There are no such thing as "American Values" because we are a diverse group of people. But we all have certain things in common. We want to be healthy. We don't want to be screwed by anyone (big business or the government).
We want to be able to manage our own health care but we don't want to have to decide between numerous health plans every year with pages of information that cannot be understood. We are tired of not knowing where all the trillions of dollars really are being spent.
We want to know the price of a service up front, and we want a trusted physician to help us decide if that is how our money should be spent. We want smart, committed physicians to know us, and not hurt us.
Sounds American to me.
Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
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