Health care is now at a crossroads.
We’ve been hearing that phrase more often recently, but what does that mean? Being at a crossroads signifies that now is the time to make a decision that will affect the future in substantial and irrevocable ways.
Why is health care at a crossroads now? Americans are getting sicker as every year passes: “A 2007 study reported that seven chronic diseases have a total impact on the economy of $1.3 trillion annually. By 2023, this number is projected to increase to $4.2 trillion.” In 16 years, that is greater than a 3x potential cost increase. That is not sustainable.
Since medicine is advancing, we are getting better at managing Americans with chronic diseases to help keep them alive for longer, thankfully. Nevertheless, we are not curing heart failure, diabetes, COPD, etc. Thus, as the population lives longer and ages with complex medical co-morbidities, it requires more medical resources, specialists, and expenditure to treat patients than in previous generations.
The next common statement in an article discussing health care costs would be to address the relevant stakeholders that are complicit in making American health care unaffordable. However, I want to highlight the cultural change that has brought us to this point: individualism vs. the common good.
As society has become more modern, there has been an emphasis on individualism, self-reliance, and independence. Previously, paternalism with beneficence was the standard in which medicine was practiced, in which a physician determines whether a patient’s wishes or choices should be honored for the best outcome. This cultural medical stance was prevalent in the 1940s during the polio outbreak. American citizens rallied together to listen to physicians and public health leaders to quarantine until the polio vaccine emerged. Then under the direction of their physicians and respect for the common good, Americans lined up to get vaccinated for polio, even though there were “only” around 15,000 cases of paralysis each year in the 1950s. With their coordinated efforts, polio decreased to less than 10 cases a year in the 1970s, and “since 1979, no cases of polio have originated in the U.S.”
Now, patient autonomy takes precedence. Even how American medical ethics is taught has changed in the last century. Medical schools are focused on teaching “the autonomy model … the premise that the patient knows what treatment decision is in line with their true sense of well-being, even where that decision is the refusal of treatment, and the result is the patient’s death.”
The hope and goal of this model is that the physician will educate the patient about all available options in their care, and that the patient will communicate their goals of care so that the two parties would be able to make the best-shared decision possible. This increased autonomy in health care was supposed to help create a more medically educated public, so patients would be understanding of equitably distributing limited health care resources as complex and chronic diseases become more prevalent.
Even though autonomy has numerous positives, recently, individualism in health care has been taken to an extreme regarding the COVID pandemic. Autonomy that was supposed to lead to a more medically educated public has instead led to widespread mistrust of the medical community due to misinformation coming from non-medical sources.
Instead of Americans standing up for the common good by taking vaccines that are FDA approved, cultural individualism has led to the death of 920,097 beloved Americans and has brought health care to a crossroads. Individualism vs. the common good is a narrative as old as history itself; however, America has been the beacon of hope and the standard of excellence worldwide for generations because of its undying commitment to the common good. Both philosophies have their place in society and health care. It is now time, again, for Americans to band together and choose the common good so we can defeat COVID and save the health care system for future generations to prosper.
Rafid Rahman is a physician and can be reached on Twitter @RafidRahmanMD.
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