HileThoughts

On a recent Leadership St. Louis weekend we learned about some of the problems of health care. Touring health facilities (the photo is part of our class on the St. Louis University heliport), hearing from the head of one of the region’s crown jewels the Missouri Foundation for Health,  and talking with others who are actively tackling health care issues in the region.

As a country the US uses 17% of its GDP for health care. Canada in contrast spends on 9.5%. Yet for all of this expense over 16% of our citizens are uninsured (based on a 2005 report, this percentage has increased significantly during the current recession). Yet we have poorer health outcomes than countries that spend much less.

With the consumer model (which I have previously derided), health care is something that one can never get enough of. Why shouldn’t I get the newest treatment, the most expensive drugs, the more elaborate tests, receive the most aggressive (experimental and/or expensive) care which will not improve my eventual outcome. The US health system based on this "it’s all about me" approach. If you have money you can have care. If not tough. If you are over 65 you can have socialized medicine. If you are younger tough. (The fact that government health insurance is great for folks over 65 and bad for people younger than that is one of the great stupidities of our country.)

It is time that we abandon the consumer model of health care and adopt a citizen’s model. Instead of how can I get the most (not necessarily the best) care for me. The question is how can we as a group best support and improve our health. Instead of how can this insurance/health care corporation makes the most money for it’s share holders. The question is how can we provide the best health care for all.

I have never been entirely comfortable with the term consumer when referred to individuals receiving mental health services - or really any health related services. The term is new, with the earliest OED citation being 1968. Initially it had the implication of a demand for high quality goods and services. Today, however,  it has morphed into implying an insatiable demand for goods and services - generally at lower and lower prices.

This newer meaning always seemed inappropriate to me when it comes to health services  but I could never quite put my finger on exactly why it was troubling. Yesterday, as I was riding my bike along the Gulf of Mexico, I heard a 2004 TED lecture by James Howard Kunstler, The Tragedy of Suburbia. He nailed it for me. The term, he opined, was problematic because it means that consumers "do not have obligations responsibilities and duties to their fellow human beings" (you can find this quote at the very end of the lecture).

For health services including those for physical health, mental health, and substance abuse we should never consider ourselves passive recipients. Rather we should be responsible for our own behaviors, should participate actively in our care, should consider it our duty to help others in similar circumstances, and should widely promote the benefits we have received. In other words, we should not be consumers but active participants and change agents.