The Democratic health care debate has focused almost exclusively on whether 15 million people will purchase health insurance on their own. That debate is important, but where is the quality debate? Why would 15 million people trying to make ends meet buy health insurance if they aren't likely to receive the attention they need? What good is mandating insurance coverage if we don't also insist that it lead to improving and saving lives no matter the socioeconomic status of patients?
I've spent my career studying what elicits change. My first book, Persuasion In Practice, described as "a landmark contribution to the field" by Public Opinion Quarterly, focused exclusively on why and how people change. It's not a fast read as it analyzes decades of theory and research -- great for academics and insomniacs -- so let me abridge.
We're creatures of habit. Even bad habits can become old friends. We know what we should have had for breakfast this morning, the amount of exercise we should have undertaken by this time of day, and what stress-reducing efforts should have been employed to assure good health now and in the future. But often we simply can't do what we should. Events transpire to preclude following our best intentions. And so our health suffers. I've learned from years as both a National Cancer Institute Fellow and preventive medicine professor that people don't do what they should do so much as what they can do given constraints on their lives. Attempts at improving health care must address this challenge. How do we make what people should do something they can do as well?
Then there is the problem of doctors knowing what they should do to help patients but being all too aware of what they can't do given time constraints and lowered quality standards of care. The result is approximately 100,000 hospital deaths from medical errors each year, hospitals rife with deadly bacteria, and patients thinking they know what their doctors advised but not being sure.
Even if you have a doctor who is knowledgeable and willing to provide the time you need, errors happen further down the line. USA Today described pressure on pharmacists to fill hundreds of prescriptions a day, often without taking time to talk to customers about dangers. They featured a little boy accidentally given a steroid that could damage his liver and stunt his growth. Much worse would have happened had the error gone unnoticed.
Which candidate is going to show us that he or she truly understands not only the need to pay for medical care but also the need to assure competent, compassionate delivery? Those are two of the brass tacks of medical care important to those with insurance and those as yet without. It's great to be able to pay for health care; it's even better to be able to live long enough to do so.
It's time to hear more from the candidates about quality of health care. This is a life or death matter from infancy to advanced age. How will patients be educated to ensure they know what to expect, what responsibilities they must assume, how to provide doctors and medical professionals with specific, critical information, and also how to locate outstanding providers? What will we do to educate medical students so that communication with patients is every bit as important as identifying their ailments? As we add more insured patients to an already overtaxed system, what steps must be taken to enhance quality of medical care? Where along the chain of health care delivery will the government exert pressure so that errors are substantially reduced, hospitals are not breeding grounds for deadly bacteria, and preventive care is made readily accessible?
How do we avoid a health care blame system, implied in presidential candidate plans, where those with chronic diseases are viewed as economic drains on a taxed system and perhaps considered victims of their own errors and negligence by those who argue that such illnesses are preventable? Some are and some aren't. Life is full of sharp curves, and sometimes you just don't see one coming. Sometimes, to mix metaphors, your number simply comes up.
These are only a few questions of critical importance to the future of health care in the U.S. Who is covered is important. What that means in terms of quality is the more challenging question -- one which presidential candidates should address with specifics that assure all voters. Because one day, not necessarily in old age, each of us will find ourselves fighting for our lives.