11/12/2009 05:12 am ET | Updated May 25, 2011

Personal Responsibility: In Education? Yes! In Health Care? No!


Healthcare and education are so similar that we have labeled them "Twins in Trouble" in the journal Total Quality Management. Each is critically important to us as individuals and as a nation. In each, the outcomes occur years-to-decades in the future after actions we take now.

Healthcare and education both have major cost issues as well as challenges in measuring the outcomes we want. Thus, it is hard to know cost/benefit for either.

In both healthcare and education, the person who pays is different from the person who consumes (receives) the service. Contrast to purchasing products such as a car or buying services such as dry cleaning.

Just recently, the President emphasized that getting an education was a vital personal responsibility. The country should provide for and encourage people to become educated because the country and the individual gain. Thus, by accepting our personal responsibility we 'do good' both for us and for the USA.

On education, President Obama echoed President Kennedy who said in his 1961 inaugural speech: "Ask not what your country can do for you - ask what you can do for your country." President Kennedy - a great leader - focused on our obligations to our country and to each other, rather than our rights or entitlements.

When President Obama gave his speech on healthcare, he spoke as though the phrase personal responsibility did not exist. What I am going to write below may not be popular or even welcome. It is what our President should have said but chose not to. In contrast to President Kennedy, saying what is popular is much more important than saying what is necessary.

Healthcare is not a right.
Healthcare cannot be a right for four reasons. (Health care - two words - is an activity. Healthcare - one word - is a system, well actually a non-system.)

Reason #1
Most people tend to see a right, any right, as our due - something we should have or get without any personal effort. We just receive health care - it is delivered like the mail. We are passive. We have no responsibility. If we view rights that way, we are in error.

Even the Bill of Rights comes with responsibilities. Our founding fathers never envisioned one without the other.

Reason #2
Health care cannot be a right because someone else must provide it. What if no one went to medical or nursing school? This is not just a theoretical concern. Applications to medical schools have fallen off 20% over the past ten years. There are over 500, 000 open nursing positions in our country. For us to have our 'right' to health care, some other person must provide it. Who? Should health care providers be slaves?

Reason #3
Good health requires a partnership of person with provider, actually of person and process. If we reject any personal responsibility, we over eat to obesity and expect health care to just take care of our diabetes, arthritic knees, and coronary heart disease. It's not my responsibility because health care is my right. If we reject any personal responsibility, then we smoke cigarettes and spend OPM (other people's money) to treat our emphysema or lung cancer.

Reason #4 why health care cannot be a right without limits The President has made it clear that our national expenditures on health care are an increasing drag on the whole country and must be controlled. There are only two people who can control health care costs: us or the Government. One of three things will eventually happen.
  • We will spend ourselves into bankruptcy.
  • The Government will control costs. Translation: central control of expenditures = rationing. That is how every "universal health care" country controls its outlay: they just never use the R-word (rationing).
  • We can control costs. Yes, we can: by reconnecting us with our money, and by us demanding a true healthcare SYSTEM, instead of what we have now: separate groups all out for themselves with us as their victims.

Fixing healthcare starts with accepting our personal responsibility. That is what the President should have said.

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