Should Personal Responsibility Be Enforced in Health Care Reform?
By Dr. Tony Magana
We know a good portion of the population will take advantage of preventive services once they are adequately explained but what about those who do not? Should society put in incentives for participating in preventive care and create punitive responses for those who do not?
One of the key issues of health care reform on which most Democrats and Republicans agree is the idea of more coverage for preventive health services. The goal of encouraging patients to do things like stop smoking, change their diets, and get routine screening is from the government’s point of view a way to cut down on health expenditures and from the patient’s point of view to improve the quality of life.
Medical studies have shown that there are disparities in American society as to who currently receives preventive services. Lower income, racial minority status, and and lower education would seem obvious contributing factors to the casual observer of whether people in the United States receive preventive services. However, a study looking at poor African-Americans in both rural and urban settings found about a ninety percent compliance with preventive measures could be obtained by making patients aware of the services and having them develop a relationship with a primary care physician. Still about ten percent of the population who was at risk for developing severe complications from untreated or undiagnosed conditions did not take advantage of preventive care.
In 2005, the state of West Virginia created a special “enhanced” Medicaid program that offered more benefits than the standard program but with a hitch. Patients who enrolled in the new plan had to agree to comply with a “Health Improvement Plan” and a “Member Responsibility Agreement”. Patients are required to read materials and attend educational classes. They must keep all appointments and follow goals set to improve their health such as stopping smoking and losing weight.
West Virginia’s approach has created significant controversy since the plan’s inception. Some medical ethicists and the prestigious New England Journal of Medicine editor voiced concerns early on in the program that “children would be penalized by their parents errors” or that vulnerable patients who would be denied care. Ethicists note that putting doctors in the position of reporting non-compliant patients to the government was inappropriate while proponents noted that physicians were given great lee way in determining whether patients were compliant.
In April, now three years into the program, a research team from West Virginia University reported that only about 10% of the eligible population had taken advantage of the enhanced plan although they said they found “wide spread support for the concept of people taking personal responsibility”. One potential contributing factor to the failure to have large enrollments was that a majority of people who did not enroll were only notified about the new program by mail many of whom it turned out had very poor reading skills.
A recent analysis by Dennis Smith at the Heritage Foundation revealed that those who did enroll in the enhanced program were often afflicted a serious chronic illness, usually smokers, and had a pessimistic attitude towards their future health. So far it is too early to tell whether the program will save a certain amount of money or dramatically improve patient outcomes over the basic plan. However, one fear that those who stayed with the basic plan would suffer more severe medical consequences with less benefits has not been realized.
Now more then ever, America is realizing that health care is a collective enterprise and no longer an individual concern. If we are asking everyone to contribute by way of taxes then is it not only fair to expect everyone to be reasonably compliant in participating in preventive services? Assuming that we should all pay more taxes initially to jump start preventive care according to the President’s plan, then should not those who are going to benefit have to contribute their compliance?
How should society deal with potentially hundreds of thousands of people benefiting from tax payer dollars but refusing to take their blood pressure medicine, check their blood sugar, exercise, or lose weight? How many times will we pay for a drug addict to go through rehab? Should persistent smokers who have had heart attacks and receiving care through the public programs not have to face some consequences?
Introducing reasonable requirements for medical compliance from people with chronic conditions for their own benefit as well as a means to control the overall medical costs of our society in my opinion would likely help garner more support for health reform. Those who wish to not participate in preventive measures certainly have the right to do so but since society can force citizens to pay for their care by taxes it should have the ability to say that coverage will be reasonably conditional on cooperation with the system.
Thanks for reading Contempo Magazine blog which discusses issues for McAllen, the Rio Grande Valley, and America from a conservative Hispanic point of view. Tony Magaña grew up in McAllen Texas, attended Texas A&M University, served as an officer in Army Reserve, and holds a doctorate from Harvard University. The co-founder of Contempo Magazine has participated in Valley business for over 20 years. He is a member of the National Association of Hispanic Journalists and also writes for the American Daily Review. Follow him on twitter http://twitter.com/contempomagazin
Copyright 2009, Dr. Tony Magana. Some rights reserved.
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