Achieving lackluster results, the United States indisputably spends an exorbitant proportion of our Gross Domestic Product on Healthcare. There are two sides to that equation: either we should be receiving better results for what we pay, or we should pay less for the results that are rendered. No matter what you believe, a conversation is warranted on why healthcare is so expensive. Irrefutably, there is tremendous waste in the system. For instance, clinical variability leads to increased cost, as does having a payment model that removes the recipient of the services from the direct payment of the services. Neither of these options is financially prudent.
These dynamics create a per unit cost for a unit of service that is not sustainable. Higher quality of healthcare provided at a lower cost requires shifting our basic principles. Furthermore, as a nation it necessitates an in-depth, self-reflection of our values, requiring us to contemplate factors we have been loath to address. Needing to be answered are questions such as, should one pay for services that aren’t substantiated by evidence and don’t deliver results for a given metric? And, is the cost of educating our providers too high, thereby inducing them to increase the price of an office visit? Moreover, are we, as physicians and hospitals, overpaid for the value we are providing? Or, is the profit margin of the insurance companies worth the value they bring? Finally, as a profession, how should we hold each other accountable for supporting a healthier society?
To answer these questions we must delve into their cause. Embedded in our Constitution is the foundational answer. Our country was founded on the basis of individual rights. Our forefathers were in a situation where they were trying to free our nation out from underneath the tyranny of King George. In doing so, having a strong bias to support the freedom of individuals, they created the Constitution and the Bill of Rights. However, we are seeing some unintended consequences of the plan. In its basic tenant, I am not suggesting that the configuration is flawed, but rather we need to either accept the situation and its results, or, as a society, we need to begin to adjust to certain aspects.
For instance, basic healthcare is a fundamental right of being a human being. However, is this right an individual or societal right? With these rights come responsibilities. Therefore, if we are thinking about healthcare as an individual right, then the individual must take on considerably greater responsibility for himself. Yet, if we are thinking of healthcare as more of a societal right, then we as individuals must recognize ourselves as members of that society, thereby creating obligations centering on the whole. We seem to want it both ways. The answer does not lie on one side or the other, but instead on how do we manage this paradox and polarity. How do we retain our individual rights within the context of societal rights? How do we both serve the community in which we live and have the community serve us?
To adequately respond, we will need to continually remind ourselves of the contextual nature of the issues. As technology continues to evolve, eventually we will arrive at a point where we can cure diseases, but at what cost and who should pay for it? These questions will become the root of the debate and it is imperative that we prepare ourselves for this conversation. If we do not, the foundations of our society will begin to crumble. Addressing the greater good requires stepping back and contemplating our individual roles within the community. As a people, we have not only the ability, but also the responsibility.