Capital Commentary is the weekly current-affairs publication of CPJ, written to encourage the pursuit of public justice.

Health Care With Dignity

Michelle Kirtley


April 24, 2009

The health care system in the United States delivers some of the best care in the world. Wealthy patients from around the globe travel here to receive advanced, high-tech medical treatment. Yet when measured against other developed nations, we trail dismally by several measures including the rate of infant mortality. More than 47 million Americans lack health insurance, and researchers estimate that more than a third of our national spending on health care is wasted on medical errors, unnecessary procedures, overuse of emergency rooms, and the like.

Our system is in desperate need of comprehensive reform. Some on the left are pushing for “Medicare for all,” or at least a public insurance option alongside private insurance. Some on the right insist that market competition is the only way to bring rising health-care costs under control.

Missing from most of the debates is a thoughtful discussion of our responsibility as a society to respect and nurture human dignity. Clearly, affirming the dignity of all Americans requires that all have access to quality health care. But merely providing Medicare-type benefits will not guarantee a healthier society. Providing insurance without ensuring access to a physician or hospital will not help rural patients who need ongoing care. Subsidizing health insurance without encouraging patients to take responsibility for their own health may actually subvert human dignity—a phenomenon that has been well documented in the welfare debate.

Patients must have an ownership stake in their own health. Research has long demonstrated that life-style changes such as diet and exercise have significant impacts on the prevention and care of diabetes and heart disease, which together affect more than 36 million Americans. Policy reforms should encourage patients to value their own health and provide incentives to practice healthy behavior as a means of affirming individual dignity and responsibility as well as managing costs in the system as a whole.

Patients should be free to choose physicians based on quality and price without having to wait for months for an appointment. Although the Medicaid program provides health benefits for millions of Americans, it has, through a series of unintended consequences, undermined the dignity of the patients it seeks to serve. Currently, Medicaid patients have to wait weeks or months to get an appointment with a primary-care physician or specialist. Many physicians refuse to see Medicaid patients altogether. Those with Medicare or private insurance enjoy better access, including lower wait times. Those with Medicaid are often treated as second-class patients. In providing access to health care for the 47 million uninsured, we must not repeat the insults to human dignity incurred in the Medicaid program.

Sustainable health reform must also consider the dignity of medical professionals and the conditions under which they practice. Reform that continues the trend of making providers more accountable to the government or to insurance providers than to their patients distorts this service-oriented profession by trying to force it into the mold of a bureaucracy.

The payment system should also be reformed so that providers are reimbursed for coordinating patient care rather than for the number of patients they see. Serious attention should be given to increasing the numbers of providers, particularly in underserved areas. Health reform that marginalizes physicians will not solve the long-term medical workforce crisis.

Wise stewardship should also serve as a governing principle throughout the debate. But Congress should never lose sight of the fact that the fundamental goal in reforming our nation’s health care system should be the dignity of the human person. 

—Michelle C. Kirtley, Ph.D.
    Health Policy Adviser
    Congressman John Fleming, M.D. (R-LA)

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Capital Commentary is a weekly current-affairs publication of the Center for Public Justice. Published since 1996, it is written to encourage the pursuit of justice. Commentaries do not necessarily represent an official position of the Center for Public Justice but are intended to help advance discussion. Articles, with attribution, may be republished according to our publishing guidelines.”