Rethinking Healthcare

The radical side in the health care debate

The radical side in the health care debate

Posting in Cancer

A doctor's loyalty is not to the market, and not to himself. It is to the patient. Treat first and ask about money second. It's like the Internet's ethic to move the "precious bodily fluids" of bits first and then look into payment. Is the Internet socialist? Is the Hippocratic Oath socialist?

Health care is a right. Health care is a choice.

Between the die-hard advocates and die-hard opponents of health reform these are the key takeaways. These are their arguments boiled down to their essence.

(Shown, from Wikipedia, is the branch plaque of the U.S. Army Medical Corps, featuring a caduceus, the ancient medical staff of Greek antiquity.)

Liberals like the late Sen. Ted Kennedy argued passionately that health care is a right, that in the richest nation on Earth no one should be made to watch their child die of cancer because they can't afford a cure.

Conservatives argue just as passionately that health care is a personal choice, a market choice. You can see these arguments, at their most eloquent, below Heather Clancy's piece yesterday on health care as a corporate responsibility.

Which side is the more radical?

The most ancient text we have on medicine may be the Hippocratic Oath. This is part of a modern version written by Louis Lasagna of Tufts in 1964:

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

A doctor's loyalty, in other words, is not to the market, and not to himself. It is to the patient. A doctor is called by ethics to treat the sick. Treat first and ask about money second.

It's a bit like the Internet's ethic to move the "precious bodily fluids" of bits first and then look into payment.

Without that ethic of act first, pay later, this medium could not exist. I am old enough to remember the 1980s, when this ethic did not apply.

The online world at that time was an elite activity for a tiny portion of the whole market. Now everyone depends on it, because of an economic model based first on service, and then on payment.

Medicine is the same way.

We know how to bend the cost curve in health care. Give doctors the power to enforce wellness guidelines. Monitor people while they are well. Don't get fat, don't smoke, exercise, drink moderately. Coaching you up to take better care of yourself wins the health care game.

This requires that the government change market incentives, as it did with the Internet. We need more primary care, not just doctors but nurses,  Physicians Assistants and health coaches. These coaches need data the way football coaches need game film. And everyone has to be a player in their own health game.

It's like the "fourth freedom" of open source, a responsibility to share your code improvements with the community. This is a very controversial freedom. My open source blog is often filled with angry talkbacks asking whether this represents more freedom or less.

All the health reform plans out there -- whether the Baucus plan, that of the Senate HELP committee, or the two House plans -- focus on increasing access to care, based on the idea that care is a right society must be responsible for.

In this it is much like the Internet or the GPL. It follows the Hippocratic Oath. And it follows the model of every other industrial country, where costs are lower and lives longer because everyone is in the pool.

So which side in this debate is the radical one? I would argue that it's those who call health care a choice, a matter solely of personal responsibility, something government should stay out of.

They're telling doctors they must violate their oath and let the poor die. They're telling those who use the Internet that our economic models are socialist. They're telling us we can have rights without having responsibilities to one another, and that anarchy is freedom.

The opposite of government is not freedom. It is anarchy. Is Somalia free?

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Dana Blankenhorn

Contributing Editor

Contributing Editor Dana Blankenhorn has written for the Chicago Tribune, Advertising Age's "NetMarketing" supplement and founded the Interactive Age Daily for CMP Media. He holds degrees from Rice and Northwestern universities. He is based in Atlanta. Follow him on Twitter. Disclosure