Why is personal responsibility so prominent in education and not even mentioned in healthcare?


Healthcare and education are extremely similar, so much so they we have labeled them “Twins in Trouble” (in the journal Total Quality Management). Both are critically important to us both as individuals and as a nation. In each, the outcomes occur years-to-decades in the future as a result of actions we take now.

Healthcare and education both have major cost concerns as well as challenges in measuring positive outcomes the outcomes we want.

In both healthcare and education, the person who pays is different from the person who consumes (receives) the service. Contrast these two crucial industries with purchasing other products such as a car or buying other 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 in that way, 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 spoke like 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 true 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 made no mention of personal responsibility. It did not seem to 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.

Health care is not a right.
Health care 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 as our due – something we should have or get without personal effort. We are passive. We just receive health care – it is delivered like the mail. We have no responsibility. If we view rights that way, we are in error.

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

Reason #2
Health care cannot be a right is because it is a service that must be provided by others. What if no one went to medical or nursing school? This is not just a theoretical concern. Applications to medical schools have consistently fallen off 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 and provider, actually of person and process. If we reject any personal responsibility, then 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 our responsibility because health care is a right. If we reject any personal responsibility, then we smoke cigarettes and spend OPM (other people’s money) on treating our emphysema or lung cancer.

Reason #4
There are only two people who can control health care costs: us or the Government. The President has made it clear that our national expenditures on health care are an increasing drag on the whole country. One of three things will eventually happen.
A) We will spend ourselves into bankruptcy.
B) The Government will control costs. Government controlling expenditures = rationing. That is how every “universal health care” country controls its costs: they just never use the R-word (rationing).
C) 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.

The first step to fix healthcare is to accept our personal responsibilities and not put them off on the government or OPM. THAT is what the President should have said.

System MD

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#1 zjin on 09.28.09 at 9:16 am

No one but you, Mr. Blogger, seems to think the notion of responsibility is not being considered. The notion of lifestyle changes and health education is forefront in most of the discussions I have heard regarding health reform. To suggest such is itself a bit irresponsible on your part.

“Health care is not a right.”? Neither is a standing military a “right”, yet it is funded without much question by the government. The Constitition says the the government shall provide for both the defense and general welfare of the country. Your semantic burble about whether health care is a “right” is an irrelevant to whether it should be an aspect of that provision of general welfare.

I would agree though, that we need a health care system, – universal health care. You have not made a convincing case, (come to think of it you haven’t made any case), an economically functional health care “system” can exist outside of a regulatory body that is not the government. Hence by “system”, I can only conculde you mean universal health care, and therefore government run health care system.

#2 deanewaldman on 09.28.09 at 7:40 pm

With respect, the notion of personal responsibility is not in the forefront; was not mentioned at all by the President with regard to healthcare, in dramatic contrast to education; and even your own comments suggest that you, like a large number of people, believe that health care (two words) is a right. Many go on to assume that since they has this right, they have no responsibility. Why should you and I pay for emphysema care for a 55 year-old two-pack-a-day smoker or a wrongful death lawsuit after a 550 pound man dies during morbid obesity surgery? Where is personal responsibility in all this discussion about health care and healthcare??

Health care should be a partnership yet the majority believes that their health is the provider’s responsibility. When Great Britain – with its NHS providing universal health care, so-called – floated the idea of patient-doctor contracts, it lasted one minute. The very idea that I have to sign a contract to stop smoking before I can have surgery! Every time the NHS has tried to inject some level of personal responsibility into its right-to-health-care mentality, it has been rebuffed.

The analogy of health care to a standing army is…weak. However, there is one point that is instructive and valid. A standing army is required to maintain national security, which is of course in the best interest of the populace. So too, a healthy population improves our global competitiveness and is in our national best interest. Should the government encourage both? Absolutely. Does that mean paying for the military and also paying for preventative maintenance on people(just like roads and bridges)? I think so but that needs to be discussed on a national level.

We have had (so far) the worst of both worlds in our health care system (so-called, because it really is not a system at all): market competition and central control both. Such a system cannot function and no, we have never tried a free market healthcare. How can you call it that when: a) some services must be given away for free; b) where competition is for the immediate dollar and not for health of patients; and c) where payments are strictly controlled but expenditures are unlimited? Supply and demand can never balance when one is fixed and the other is variable.

#3 zjin on 10.01.09 at 3:48 am

You don’t seem well informed on this issue since the current health reform bill does have funding provisions for health education and improvements to primary care in that regards. Moreover I just saw on today’s headlines, “U.S. senators vote to encourage healthy behavior” (http://www.reuters.com/article/topNews/idUSTRE58T7IU20091001). Almost every discussion of how to get health care costs down in the long run revolve primarily around projected improvements in behaviors which contribute to complications from chronic diseases.

Your verbose nonsense about “rights” starts nowhere and ends nowhere because you are babbling about semantics mostly. There is no relevant point in it. Relevance is in the results. The cost containment of per capita costs for countries with universal health care begins at half that of the U.S., and often with higher rates of usage of services per capita than US counterparts. Overall health outcomes generally are as good also. So it is vastly less expensive and produces good results…even without improvements in “responsibility” education.

As you may be aware, all developed countries today have similar rates in behavioral vices, so the US does not particularly stand out any more in that regard. In fact I read a survey a couple years ago that showed higher rates of obesity in some areas of England and Germany than in any place in the US.

The analogy I made between healthcare and defense is strong, and you even go on to explain one of its strengths, ironically.

Overall, your response is just as confusing as the original blog. A free market by definition is going to eventually pursue the “immediate dollar” as that is how economic markets usually operate, so your rant is confused. You are not going to have a “free market” that is not about the “immediate dollar” regardless the fantasy world you live in. The only thing that can enforce otherwise are government regulations.

Moreover, if [healthcare] services are not “given away for free”, (I presume you are criticizing critical care laws here rather than volunteer work), then you are simply wishing uninsured morbid patients to “die quickly”, to paraphrase a Congressman I heard recently. Even with such “free” care, uninsured will die at double the rate of insured patients with similar injuries or disease, even within the same hospital as studies have shown. So the care is hardly free.

Supply and demand in healthcare is already out of balance and always has been. You are babbling economic cliches without comprehending their meaning. Demand in healthcare has little to do with its supply. People demand healthcare because they need it. Rates of injury and illness (or perception thereof) set demand, not the supply. The supply simply limits whether that demand will be satisfied. If the free market’s solution to triaging demand is to simply let some who can be saved, die on the basis of economic status, then that is not a healthcare solution that is based on any ethical principles. And rights are, ultimately, about ethical principles.

#4 Nerdse on 11.01.09 at 12:42 pm

I have LIVED in the UK. Besides long waiting lines, they do ration healthcare, & they do NOT forgive vices. If you have ever smoked or been overweight, you are not eligible for a cardiac bypass – even if you are now normal sized & haven’t smoked or been fat in over a decade. You must go to the private sector & pay yourself for what you want. Those who have ever been fat are also denied joint replacements, even if the cause is rheumatoid arthritis & not obesity in their past. And every person who has a serious fracture & requires emergency medical treatment of same, will push the entire list back, increasing wait times. For every waiting list for every elective procedure, those who’ve smoked or been fat are not a part of it.

You’re correct, therefore, that rationing does occur.

If obesity has soared that high in incidence in the years since I was last there, might I again suggest that REAL research into a contagious or infectious disease process, with/without adding in genetics, might find a cure. Not for obesity caused by mindless eating, but for people who remain baffled that eating 1200 cal a day or less, most days, does not result in any weight loss whatsoever.

Might actually work to quit blaming the victim & try to find a cause & cure. People in 3rd world countries who are fortunate to lay hands on a 500 cal intake in a couple days shouldn’t become obese diabetics.

There HAS to be an answer. Why not start looking for something in the DNA of competitive eaters, who are mostly thin people who are gluttons, practicing eating to the the tune of 4000 plus cal a day or more. Then find out what they have that fat people don’t have. Maybe you can stop the appetite while you’re at it, for those fat people who got that way the good old fashioned pigout method.

Quit whining about it & try finding real answers. And I don’t mean you continue your rant on fat people as the root of all evil. Self righteous twits like you are the root of much evil in the world. You don’t investigate – you make money from their misery while doing nothing to restore balance.

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