Health Reform Gets Personal

Health reform related activity has picked up in recent weeks. Congress, President Obama, and the media are focused on remaking the U.S. health care system. Readers wishing to keep up with the latest news should read Kaiser Health News, visit the Kaiser Health Reform Gateway, and subscribe to Ezra Klein’s blog at the Washington Post and Jonathan Cohn’s blog at The New Republic.

However, there have been some relevant events that have not been covered by other sources, and for good reason. They’re very personal. In recent weeks three family members have had significant interactions with our health care system: triple heart bypass surgery, an appendectomy, a major gastrointestinal illness, and the delivery of a baby. The varied experiences of the patients in each of these events was directly related to the nature of U.S. health delivery and their insurance coverage, or lack thereof.

One family member saw one of the nation’s leading surgeons. Another received adequate care only after a fight and at great personal cost. A third was nearly the victim of unfortunate (and very common) provider incentives that did not necessarily align with the best interests of the patient. These experiences reflect the structure and incentives of our health care system. Me, my family members, as well as you and yours, would have different health care experiences and outcomes under a different system than we have under the current one.

This is the personal side of health reform. As policy makers and reporters/bloggers debate the major health reform issues (public plan, taxation of employer benefits, cost to government, etc.), I am also focused on my family’s struggle to get the best out of our system. It isn’t easy. The results are not always good. And it doesn’t have to be this way.

No matter the outcome of the current efforts at health reform, each of us will judge our health system by personal metrics. Did you get to see a good doctor when you needed one? Did you receive the right care? Were there medical errors? Did it cost you a fortune? Did the system work for you? In the throes of a health emergency you will not care if you are insured by a public or private plan or if the 10 year federal spending projection is $1.3 or $1.6 billion or if you’re paying a tax on your employer benefit. You will only care about the medical treatment you receive. You will judge the health system on how it treats you and your loved ones.

Health care is personal. And that, in a nutshell, is why health care spending is so hard to rein in. I don’t believe we’ll make a significant dent in health spending until the spending itself is made as personal as the care it buys. I have no doubt that one day our health system will be structured that way. We’ll each pay more for the care we receive and providers will be paid for delivery of quality, not just quantity, of care. I’m not optimistic that the current round of health reform will take us very far in these directions. I’m also not convinced we’re ready to face the very personal choices such a system demands.

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