Reliving History and Renewing the Health Care Reform Debate

Drs. Derose and Lurie (Ann Fam Med 2006;4:388-390), quite elegantly discuss current policy issues in the ongoing health care reform debate. However, to achieve the desired result of high quality, patient centered health care, delivered at reasonable cost to all Americans, the role of the patient as consumer must be addressed. No true debate on health care reform can be achieved with a public that is blind as to the consequences of their actions.

Americans eat, drink and smoke too much, and exercise too little. Obesity, diabetes, and heart failure, often diseases resulting from poor lifestyle choice, are treated with expensive medications and procedures when the best treatment is diet and exercise. In a nation desirous of easy quick fixes, pill popping is preferred over a healthy lifestyle.

In a recent national poll, only 13% of respondents felt that Americans not doing enough to maintain a healthy lifestyle was responsible for high health care costs (1). In a survey conducted by the Kaiser Family Foundation, Harvard School of Public Health, just 4% of those surveyed felt that people with insurance having little incentive to look for lower prices was the most important factor in rising health care costs (2). However, in that same poll, 73% felt that drug companies and insurance companies, greed and waste in the system, and the rise in malpractice suits were most responsible for rising health care costs.

Although the increasing costs of health care have been widely discussed by physicians, the media, hospitals, and politicians for years, too many Americans still refuse to personally engage in the discussion. When asked if increased health expenditures had caused them to more carefully discuss treatment options and costs with their physicians, 41% of Americans fail to do so (3).

We do need a health care reform debate in this country, and the issues raised by DeRose and Lurie, are important components of that debate. However, to achieve these goals, the American public must recognize its roll in the problem as well as the solution. Much of our current crisis is attributable to politicians, employers, physicians, and others not having the will to insist consumers be part of the solution. There are tough choices to be made, but we as a society will be successful in reforming health care only if an informed and engaged public accepts responsibility for its own health.

1. New Models National Brand Poll. Conducted by Winston Group. August 31-September 1, 2005. 2. Henry Kaiser Family Foundation, Harvard School of Public Health, USA Today Poll, April 25-June 9 2005. 3. Employee Benefit Research Institute, June 30-August 6, 2005

Competing interests:   None declared