Fixing U.S. Healthcare blogsite has laid out the mounting need for healthcare reform and a compelling case for Oregon-style cost-benefit approach as the foundation for it. But this blogsite’s reasoned arguments from history, politics, finance, and ethics are not enough. Americans need a rekindled core idealism to impel them toward reform.
Here are three key ideals that could reignite a can-do confidence to carry us forward with healthcare reform.
- Realistic appraisal of relative value of healthcare. Americans are coming to understand that healthcare does not have infinite value. Rather, cost-benefit analysis – and common sense – tells us that some services are highly effective but that others are hardly worth the money. Consumers are growing to appreciate that healthcare also has a finite comparative value with respect to other individual goods like food, clothing and shelter and to other public goods like education, research & development, infrastructure, national defense, and civic order. All Americans want and need basic care that is available, affordable and responsive; they have no patience for waste that only drives up costs.
- The System must bend to its mission. In this new age of institutions, America and peoples around the world increasingly recognize the challenges of institutional governance, oversight, ethics, and management of public trust. All individuals working within institutions need always to monitor for mission failure, corruption, “administrative evil,” and distrust. Up and down the chain of command corporate citizens should constantly strive for accountability, transparency and public engagement. Mission scrutiny should not be an afterthought nor only a reaction to scandalous violations. Rather governance and oversight should be seen as integral structures for orderly institutional function, proactively built into institutions, in recognition of the temptation of corruption inherently caused by power and money. Whistle-blowing should be encouraged, facilitated, and protected, so long as done without malice. These ideals hold not only for healthcare institutions but also for all public, private and non-profit institutions and for transnational institutions such as business, finance, trade, diplomacy, and connective technology.
- Convergence of liberty and service. Leaders at all levels should cultivate an ethos of interdependent solidarity. Individual liberty should first be affirmed but then taken to the next level of altruism, service, and dedication to the common good as the highest expression and fulfillment of that individual liberty. This ideal has guided the “better angels” of our most revered statesmen – think of Washington and Lincoln — and it underpins today’s most respected pillars of our nation, for example our military and the nursing profession.
As a doctor, I for one have had the privilege of daily living out a profession permeated with the ethics of service and dedication to the good of others. After starting up and running a private practice, I later held leadership and teaching roles in a non-profit teaching hospital, a public nursing home, and a federal healthcare system. Each of these institutions had governance and oversight structure that effectively guided them in day-to-day furtherance of the healing mission. And these same structures helped identify and remedy lapses. I can affirm from my lifetime of experiences that institutional checks-and-balances can work, that a large majority of humans yearn for participation in a mission larger than themselves, and that leaders can guide with meaning, attention and trust for their teams to continually reach toward their mission.
Americans need to embrace an ideal of hope and we need to reject cynicism and despair. Healthcare reform will bend to Yankee ingenuity and to American idealism. This is our national American heritage and can be our renewed destiny.
Now, take action.
- Applying our Values & Philosophy to Healthcare Reform
- The Big Fix (Oregon Health Plan of 1994)
- How Could Oregon-Style Healthcare Reform Satisfy Liberals, Conservatives and Libertarians?
- Dzau V et al. Vital Directions for Health and Health Care JAMA April 2017 https://jamanetwork.com/journals/jama/fullarticle/2612013?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jama.2017.2962
- Berwick DM. Vital Directions and National Will (editorial) JAMA April 2017 https://jamanetwork.com/journals/jama/fullarticle/2612012?alert=article
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