Ten Commandments of Health Care Reform: A Patient’s Perspective

submitted by: admin on 10/16/2013


1) Access to good health care is a human right.

No one in the United States should lose a home or have to file bankruptcy because they get sick. None of us should be denied access to healthcare because we have experienced an illness in the past. Those of us with a “pre-existing condition” need more care—not less care.

2) I am my brother’s keeper.

The health and well being of any one of us matters to all of us. The proper role of government is to insure that care is not only available—but actually delivered—to each of us – on behalf of the rest of us.

3) Insurance companies that want to make a profit must earn their money “the old fashioned way.”

Simply providing access to the health care system or paying a claim is not sufficient—because we are the ones that gave them the money to do this in the first place. Insurance companies earn the right to make a profit by doing two additional—and very important—things beyond just paying a claim. First, they gather information on how patients are being treated, and analyze these data to help grow our collective understanding of “what works.” Second, they make this knowledge available to doctors to help them improve our chances to enjoy better clinical outcomes, i.e., “get better.” What they do to help caregivers deliver better treatment is what earns them the right to make a (reasonable) profit.

4) Medicine is a profession and a calling—and not a “profit center.”

Physicians and other professional caregivers should be very well paid for the valuable service they provide. However, what we pay them for any care they deliver should reflect not only the cost to the physician, but also the benefit to the patient.

5) We have to start paying our doctors for “talk time.” Time that a physician spends in really talking to a patient—and listening to that patient—is critical to both diagnosis and treatment. Countries that have larger percentages of physicians in family practice rather than “specialties” have better public health indices.

That “Norman Rockwell family doctor we used to have” gave his patients something very valuable—his time. Perhaps the single thing that patients say they want now, and don’t receive, is more time with our doctors. Giving a physician a chance to take a detailed patient history, and to get a full description of "what’s really going on" around whatever “complaint” brought that patient into his office, is at least as valuable as any test or procedure performed. We have to stop running our doctors ragged, and quit driving them out of medicine altogether. We must begin to allow them the time it actually takes to practice good medicine.

6) Preventing disease is less expensive than curing disease, and it’s also much more valuable.

Treatments that prevent disease should be reimbursed on an equal footing with those that “cure” and/or “manage” a disease that’s been allowed to develop. Prevention costs less in terms of both human misery and dollars. Health care professionals will begin to shift their practice models towards health promotion when we begin to reimburse for the treatments and services that this perspective requires.

7) What we as patients do for ourselves probably matters more than what the health care system does to us—so come on people—what’s it going to take for us to start doing it?

Lifestyle issues (i.e., diet, exercise, vitamin and mineral supplements, sleep, stress levels, religious/spiritual practices, and even “play”) are often more powerful than drugs and surgery for the prevention, treatment, or “management” of the majority of complex chronic illnesses. These deserve serious consideration, equal respect, a dedicated investment in consumer education, and direct financial support where appropriate.

8) Patients have a right to be educated and informed on all aspects of their health care issues.

We deserve the ability to participate as an equal in any and all of our health care decisions. Doctors in the past somehow assumed the sole responsibility for “life and death”—gallant, but inappropriate. Patients were supposed to be compliant, i.e. “to do what we were told.” But we patients have a responsibility for our own lives, and we are the ones who will experience the consequences of any treatment decisions made on our behalf. We have a right to a real voice.

9) Having a doctor who understands us is critical to our ability to get good health care.

More than one type of wisdom is required to make the right health care decision for any individual patient. Medical professionals cite the importance of “the science” to their ability to deliver quality care. They are not wrong. But how well they understand a disease is only half of what it takes. The other half is how well they understand us—the unique human being standing in front of them. That wisdom comes from common sense, compassion, and a willingness to be human and sometimes even vulnerable. And perhaps most of all, it comes from being willing to listen.

10) The “best health care system in the world” will do two very different things (see below) with equal skill and passion—and it will operate with a lot more compassion than it does right now.

First, it will continue to make wise use of all our fabulous advances in technology and shared scientific knowledge. But it will also return to something we’ve lost—a real commitment to supporting the human relationship that always sits at the heart of healing.


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