Only the public can truly reform health care
The News Journal published the following opinion piece by Robert Laskowski, M.D., Christiana Care president and CEO, on Friday, Jan. 21.
With Wednesday’s vote in the U.S. House to repeal health care reform, the likelihood of renewed political posturing and simplistic sound bites sadly appears inevitable.
It is highly unlikely the banter will contribute much to our ability to effectively address our personal health needs, our community’s health or our ability to pay for the health care we as a society want but are increasingly less able to afford. The reason for this is not just that the nature of partisan politics often obscures rational discussion.
The deeper and more important truth is that the key to true health care reform lies not in Washington, nor in our state capitols, but in our own hearts and minds as citizens. And, we the public, remain largely passive, often confused, and mostly inactive.
If we as individuals do not become active agents in managing our health, the best features of the Patient Protection and Affordable Care Act will do little to protect anyone and be unlikely to affect affordability. Some facts to support these assertions:
First, more than 50 percent of all deaths in the United States are directly attributable to the lifestyle choices we make.
No externally driven system will compel us to live healthier lives. We must first make a personal choice to live healthy and then compel the systems that comprise health and medical care to support these choices. “Health” insurance will then support health, not “medical loss ratios” or “corporate profits.”
Our choices are not merely personal ones. When we as a society do not choose the social and economic factors that stimulate good health — good education, good jobs, safe neighborhoods — we avoid choosing health.
We spend much of our waking hours at work. So, our workplaces too should facilitate our health. We should settle for nothing less. Our lifestyle choices, in their many explicit and implicit forms, result in the health care system we have today. To change our system, we need to change our choices.
Second, a renewed focus on the value of health care is needed. Harvard Business School professor Michael Porter writes in amazement at the lack of “value” as the basis for the economics of health.
Value in health care is not just about cost and price. To reduce the concept to a simple economic transaction reduces health care to a commodity. Both patients and the physicians who serve them know this is simply not the case. The character of a good doctor-patient relationship is unique to every patient. We want our care to be tailored to the unique needs of the patient. It is not a commodity.
Health care that has “value” makes a positive difference in a person’s life with a cost they can afford. It does and should not imply “cheap” or “rationed” or “low tech,” but “clearly useful” and “worth our time and money.”
“Value” is not a concept that can be legislated; it is inherently subjective. It is the perspective of the one being served that determines value.
To realize true reform, patients must be active agents in their health care. When was the last time you asked your physician: “Doctor, tell me what difference having this test will make?” To be the best doctor I can, I need to know what my patients want, not just what I think they need.
The patients we serve can help us, and more important, themselves, by always asking us questions about how our recommendations help them. If there are five equivalent procedures, why is one recommended?
If a particular treatment offers little benefit, the patient should know it. If a medical device is the most expensive, does that necessarily mean it is the best? Surgery done with robots may be better, the same or worse than more conventional surgery. But patients beware: Do not tolerate unsubstantiated claims of superior performance or fall prey to the false assumption that “higher tech is always better.”
It is only through stimulating meaningful public dialogue on important issues about health that true and sustainable change will take place. Noisy town meetings and hostile rallies continue to dampen robust dialogue.
The discourse on health care should be taking place regularly with our family, our friends, our neighbors, our co-workers, our employers, our doctors, nurses, and yes, our politicians.
The maxim that “without our health we have nothing” is all too true. We the people cannot afford to let others decide for us. It is only by our action that we can be assured of the healthy lives we all deserve.
Robert J. Laskowski, M.D., is CEO of Christiana Care Health System.
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