Archive for April, 2011

The Choice: Customer or Beneficiary

It’s been a long time since I blogged here. I had become concerned that I would be seen as speaking for the organization from which I draw a salary. I do that in other forums, willingly and with pride. So, while I would assume (hope) that many of the wonderful people for whom I advocate would agree with me here (or at least find what I say to be provacative enough to cause them to think), this blog does NOT express, nor is it endorsed by the NJAFP, the AAFP, or any of their members.

This morning I read an editorial by Paul Krugman of the NYT. While I agree with some of Mr. Krugman’s points, and disagree entirely with others, what jumped out at me today was that everyone who has something to say about our broken, fragmented healthcare “system” is able to clearly (and usually articulately) identify what they believe to be the source of the problem. Few however, offer solutions other than very typical, and usually partisan (a la Krugman) ideas that are often rejected by large portions of the electorate (and I’ve become convinced that this is all we are to most politicians…a measurable commodity on their march to power). Given that I am also long on problem and short on solution, maybe I am no different. That said, there is an 800 lb elephant in the middle of the room, and we need to begin as a society to talk about it.

The foundational problem is that our culture has become to quick to depend on “someone else” to take care of us. Greed and laziness are leading too many to NOT understand the consequences of “what they want.” The other day as a part of the budget debate, the president said (paraphrasing) “most Americans hate gov’t spending but like what it buys.” I disagree. I think that most Americans like what it buys THEM as long as they feel that some OTHER schmuck is doing the buying. This is the issue with healthcare. Most WANT their care to be the “commercial transaction” that Mr. Krugman eschews, as long as what that means is that such a transaction comes with all the protections and control that we gain as a paying customer…we just want someone else to pay the bill. Until we wrap our arms around that issue and make some tough decisions. The question that we need to ask ourselves with regard to our healthcare is “do we prefer to be customers, with all the rights, protectections AND RESPONSIBILITES that go along with being the person who pays the bill, or would we rather be “beneficiaries” — which by definition requires that we give up some control to those who pay the bill? I am well aware that in the commercial system as it currently exisits we are in many cases paying an “insurance company” who doesn’t treat us like a customer either. I am not debating the merits of a commercial system vs. a government funded system. I am however, suggesting that the root of our problem is, to borrow a phrase, “uniquely American.” We tell ourselves that we are the most fiercely independant culture on the planet. That is certainly a quality that has served us well throughout our rather young history. However, I fear that for many the interpretation of independance has conveniently eliminated the responsibility that is its prerequisite. Mr. Krugman is right. We can’t be “consumers” in a “commercial transaction” with the healthcare system if our neighbor is footing the bill. The flip side is that if we ARE consumers, there will be some who can “afford” more than others. Neither option is perfect.

Consumers or beneficiaries? I think we need to choose.


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