With Rights Come Responsibilities

Rosenthal has done it again. Her An American Sickness was a brilliant, insightful indictment of our dysfunctional healthcare system, along with some potential remedies. Now her recent Nine Rights Every Patient Should Demand details nine financial rights we should all expect from our healthcare system. They are all things that we should, indeed, expect — demand! — but, unfortunately, don’t seem to typically have.

I agree with Dr. Rosenthal’s suggestions, but they made me think about what responsibilities come with such rights. 

Let’s face it: virtually all of us could be in better health. Almost all of us could take steps today to improve our health, and even more steps tomorrow. That more of us don’t take that responsibility is baffling, because no one will benefit from our better health than we will. 

I’m not as ambitious (nor as smart!) as Dr. Rosenthal, so I’m only going to list seven proposed responsibilities:

1.  The responsibility to ask “how much”: We talk about wanting more price transparency in healthcare, as well as how difficult that is to meaningfully have given its convoluted pricing approaches, but nothing will happen until we start asking about how much things will cost. All. The. Time. In the short term, health care professionals will plead ignorance or try to explain why that is a hard question to answer, but eventually those responses will not do. We are never going to get the answers unless we start asking. 
2. The responsibility to care about costs: We all-too-often tend to think of healthcare services as free, and/or priceless. That is, we expect our services to get paid for with as little outlay from us as possible, and without really caring what they might cost anyone else. A million dollars for a new drug? That’s what insurance is for, right? Well, no; any form of insurance, whether public or private, has a limited amount of money. We should treat our spending as though every penny comes from us, and recognizing that money spent on our healthcare is money that can’t be spent on anything else — and sometimes should be.
3. The responsibility to ask “why:” It has been increasingly accepted that there are a lot of unnecessary healthcare services, perhaps a third, maybe more. In An American Sickness, Dr. Rosenthal outlined some of the types of unnecessary treatments and surgeries, and it wasn’t an exhaustive list. We get excited about new prescription drugs, without recognizing that most drugs do not help most people. Enough is enough. We’ll keep on getting over-treated until we start demanding to know what the odds are that proposed treatments will actually help us, and having hard discussions about cost-benefits.
4. The responsibility for our own health: Face it, most of us have delegated our health to the health care professionals. We think we can get away with poor health habits because, well, other people are worse, and besides, if something bad happens, our doctor can just give us a pill or perform a surgery. That doesn’t work. It is not their health; their responsibility to treat us is not the same thing as responsibility for our health. We have to own it; we have to live it; we have to make caring about our health an integral, ongoing part of our life. That is easier for some of us than others — attribute that to good genes, good luck, good circumstances, or whatever — but we all have the same responsibility.
5. The responsibility for others’ health: We don’t live in a vacuum. Our actions, or inactions, can greatly impact the health of others. It’s not just about trying to avoiding passing along a cold or the flu. It’s also about making sure people have clean water, enough food, a safe environment, and access to affordable health care, to name a few. We have to realize that other people’s health matters too. We can contribute to their health through our taxes and/or health insurance premiums, through how we vote, by fighting pollution and poverty, even just by encouraging them in their health efforts. It is possible to only care about our own health; it is just wrong to do so. 
6. The responsibility to say “enough:” We’ve all seen the TV shows where heroic doctors perform CPR on a dying patient and miraculously save them. Unfortunately, usually that is just on TV; in real life, things don’t usually work out so well. Similarly, we all have come to expect doing everything possible to keep us or our loved ones alive as long as possible. But health isn’t just about being alive, and life isn’t either. Quality of life matters. Is giving a cancer patient 2 more months of life really worth the added side effects (or costs)? Should your dying 95 year old grandmother really get admitted to the hospital for more treatment? Are premature babies worth every effort, at any cost? These are hard, hard questions, but we have to start asking them, and take responsibility for when it is time to say “enough” to more health care. 
7. The responsibility to expect better: In most walks of life, we expect things to get better. Lower prices, better products, more services, added convenience. In healthcare, though, we seem to be more passive. We accept long waits, incomplete answers, inconvenience and even indignity, incomprehensible documents, steadily increasing prices, and bad outcomes. It’s just healthcare, we shrug; what are you going to do about it? Well, for a start, don’t expect it, and don’t accept it. Complain. Suggest. Demand. Make it better. 

At the end of the day, responsibility for our health must be ours. And, whether we like it or not, the same is true for our healthcare system. Our healthcare system has much wrong with it. Some would say that calling it a “system” is a stretch; it wasn’t designed or purposely built. It has evolved, in ways that no one intended and few would have expected. It is not the system that anyone would choose.

It’s not as good as it could be now, and it is not anywhere near as good as it is could be in the future. Getting to the latter will require a lot of smart, dedicated people taking responsibility to make it, and their health, better.

Starting with you and me.