Healthy Discussions

Reform (v): make changes for improvement in order to remove abuse and injustices

One of the reasons juvenile correction institutions were originally called "reform schools" stems from the definition above: these facilities existed to protect youths from abuse in adult prisons. The offenders needed to be separated from other kids but placed in a setting that would be rehabilitative, with the goal that they would reform their behavior for the better.

Break reform down and you get re-form, an opportunity to form again. While policies and programs are not Play-Doh and shouldn't be tossed into a new format every time someone grows bored with them, they possess the pliability that allows them to improve. And the passage of time, the excitement of discovery, the changing needs of a group require that policies and programs re-shape, re-vitalize, re-form.

Reform is one of the hot button words of the moment, primarily due to the current push to reform health care. This shortcut term contains some inaccuracies: it is not care that is being reformed so much as access to and cost of health care that could be altered. Changes to care should come from medical professionals. The current overhaul is coming to us courtesy of political professionals -- politicians, lobbyists, and the like.

Does that doom this reform effort as a bad idea? Far from it. People without insurance use emergency rooms for their primary care. That group of individuals is growing as jobs grow scarce and jobs with health insurance benefits even more scarce. Do you have a pre-existing condition? Don't change jobs or you may not get insurance. How old are you -- adding pill bottles to your medicine chest faster than candles on your cake? And when it comes to personal reform, some people use the power of preventive activities improve their health.

That latter group obviously is taking responsibility for their health. But does that mean all the others aren't? Getting a better job seems pretty responsible -- should one turn it down because of a bad back or enlarged prostate? Do we celebrate old age or cut off their meds at age 85? When a self-employed head of a family loses what little insurance he had because premiums sky rocket and then loses his business and home because his child needs extensive medical care, is that being irresponsible?

I raise this issue because in the great reform debate, the word responsibility seems to rear its head constantly, the implication being that anyone without insurance and means to pay for health care is being irresponsible. For some, that's true, but what about all the scenarios above? What about the healthy person who has been turned down by every insurance company receiving her application? What about the person whose insurance doesn't cover a sudden catastrophic event?

What is irresponsible is not seeing that the current system truly needs reform. What is irresponsible is defending the status quo that is the current system. What is irresponsible is pretending other systems (such as the one in Canada) only kill people. What is most irresponsible is erecting roadblocks to reform only to score political points, not because one believes that reform shouldn't happen. (Senator George Voinovich of Ohio recently acknowledged that's the true motivation behind about 50% of the political anti-reform rhetoric out there.)

Many legitimate concerns are being raised about reform. If you're interested, Arthur Caplan has an opinion piece at MSNBC at http://www.msnbc.msn.com/id/32083506/ns/health-health_care/ that helps sort fact from fiction among the claims being made against health care reform. The real ones should be considered, but the false ones, once debunked, should be ignored and left by the road side. Reform will take too much effort to waste any on urban legends and myths.

It is also irresponsible not to admit that the health care system in the United States is already a multi-tier system and will remain so no matter what reform brings. People with means will always have access to the best care. The myriad options being discussed, including a public one, do not preclude private coverage or personal choice.

As a society, we must acknowledge our role in this growing tsunami of health care costs. Physicians order test after test not because a patient necessarily needs them but to cover themselves if sued. We have become so used to bigger and better technologies bringing instant gratification that we expect and demand the same from medicine and health care. We want immediate cures to problems we bring on ourselves. Case in point: the FDA initially considered the anti-obesity drug rimonabant "approvable" but pulled back after a long look at the drug's safety profile. The problem with rimonabant? Its major side effects are suicidality and depression. Seriously. Suddenly a treadmill looks a whole lot more appetizing.

We want all this at the lowest cost possible. While that may not be possible for every test or procedure, surely it is a goal that must be sought. Bottom line -- too many people cannot afford health care. They can't afford insurance, they can't afford medication, they can't afford care. They aren't being irresponsible, they are being beaten down by the expense. Maybe they can pay for a single visit to the doctor, but not the necessary follow-up. Perhaps they can afford most of their meds, but only if they split pills to make them last longer. Maybe they can cover insurance premiums, but the deductibles for hospitalization put coverage out of reach.

Reforming costs and coverage to provide access to health care will require active support and participation from those who profit from health care. It should never mean that they lose every cent they earn, lose their ability to deliver care, lose their capacity to compete. Increased competition is truly needed in this reform -- we could definitely benefit from more insurance companies offering coverage and more clinics and facilities in rural areas, for example.

Health care reform is a complicated but vital mission. It is especially telling that the nudge needed to open the door to reform appears to be coming from many parties, including those in the health care industry itself. Parsing out costs and access will not be easy and all possible permutations should be considered. It will take time and energy on the part of those who will ultimately determine the shape this reform will take. It will benefit from their varying experiences and expertise. What it won't benefit from is the nonstop rhetoric and partisan sniping we have had to consume since these efforts began in earnest.

Access to and cost of health care in the United States can be improved. Bringing about health care reform is truly the responsible thing to do.