The demise of personal responsbility and the necessity of reinvention

A few months ago I visited my primary care doctor.  Fortunately (or not) he knows that I’m pursuing a career in health care administration and so I receive the longer than the (less than) standard 10-minute primary care visit.  That extra time is spent discussing health care reform, not my health (still, very valuable, especially since listening to insight provided by physicians like himself will be important to my future financial health).

We got to talking about pay for performance and physician incentives.  His (very accurate) contention is that payers cannot only hold physicians accountable for better outcomes, they must also (very accurately) hold patients accountable for personal decisions affecting those outcomes.  While measures are beginning to do just that, we have a very long, long way to go.

The problem is one of culture.  Long a nation of personal responsibility (“pull yourself up by the bootstraps”), we’ve (the U.S. of A) recently (it’s probably been a long trend downward) entered an era of diffusing responsibility that is having an extraordinary impact on our health.  Whether or not you are a proponent/evangelist of the consumerist movement in the health care industry, agreement must be reached on this point: personal responsibility in daily decisions of health must improve (greatly!).  It is becoming clear that increasing the financial burden on patients to incent more healthful decision making isn’t creating the dramatic improvements necessary.

We’re obese (and getting larger).  We don’t do well with preventative physician visits.  Our eating habits are atrocious.  We exercise dramatically less than we watch television.  We’re becoming more dependent on drugs to correct the problem.  It’s getting really, really bad.  Modern medicine has been the saving grace of many, many patients.

Current events are only decreasing the notion of personal responsibility.

Our banking system will (hopefully, hopefully) be made all better by a government cash infusion of billions of dollars (one that cost more than the Marshall Plan, Louisiana Purchase, trip to the moon, savings and loan bailout, Korean War, New Deal, Iraq War, Vietnam War, and NASA’s entire lifetime budget COMBINED!) after many people made bad, bad decisions.

The (not-so) Big Three are asking for money, too.  This one is going to cost significantly less than the above (reportedly only $10 billion…for now, the charade that was flying on private jets and then driving to D.C. was obviously realized) for companies that badly managed the move toward fuel-efficient vehicles (not to mention their only very recent introduction to good design) in an industry that some say won’t survive (that’s capitalism, by the way).

Our local governments are in trouble, too.  States across the nation are preparing for record-setting shortfalls.  Some mayors have even asked for bailout assistance.  Philadelphia mayor Michael Nutter said, “I want to make sure that cities and metro areas are at the table, that their voices are being heard, that our challenges and problems are well understood, so that we can get relief.”

Many people are looking for relief.  It must be one of those “do as I say, not as I do” moments.

The problem here is that a cash infusion into our personal health can’t fix our health problems.  While the government can try like heck to fix the economic problems we currently face by printing more money, we can’t create more years of life when we reach the unhealthy point of no return.

We need nationwide behavior change.

Even bariatric surgery patients must change their diets; for even after a surgery if a patient returns to eating habits of old, the weight will come back.  A heart bypass surgery patient must change food intake and exercise habits.  The same can be said for any number of current health care procedures.  But the point is, as our collective health worsens, we must start taking action before we have to undergo medical/surgical treatment.

But how, one might ask?

Invest in primary care.  Seriously invest in primary care.  Whether it is done through loan forgiveness or more closely aligning specialist and primary care physician salaries or some other tool (the debate can be had), it must be done.  That less than 10-minute face time with a primary doctor, inexcusable.  People listen to doctors.  Look at me, I’m writing about it after conversing with my primary care doctor.  Start the behavior change in the exam room.  Obviously we need to invest in a personal responsibility campaign, too.  We also need to properly incent patients to follow marching orders (trips to Hawaii? shopping sprees? money off premiums/co-pays/deductibles? community recognition? it’s obvious reduced life expectancy isn’t a big enough stick…).  I look forward to hearing about what other ideas you may have.

Let’s get back to personal responsbility.  It truly is the only tool that will save us.  Diatribe over.

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