Are our pre-conceptions influencing our thinking?

Health Care Reform and ‘American Values’

Excerpts from a New York Times Health article

By PAULINE W. CHEN, M.D.
Published: September 10, 2009

I was born, raised and live in the United States, but recently a neighbor asked me, “What are you?”

As the daughter of Taiwanese immigrants, [I]was not, at least in his eyes, entirely American.

“Well,” I said, “tell me first, what are you?”

“I’m an American!” he replied without a moment’s thought. But then he asked once again, “So what are you?”

According to Dr. Allan S. Brett, a professor of medicine and bioethicist at the University of South Carolina, politicians and pundits from both sides of the aisle are now doing the same, using incorrect beliefs about “American values” as a smokescreen in the health care reform debate.

Dr. Brett writes, “[T]he underlying premise is that an identifiable set of American values point incontrovertibly to a health care system anchored by the private insurance industry"

I spoke to Dr. Brett recently ...

Q. What assumptions do public figures have when they use the term “American values”?

A. They assume several things. [pick any american and you can]make an inference about what their views will be and what they deem important . But anyone with his or her eyes open knows just how heterogeneous we’ve become in this country.

The concept of American values is used to tell people what they should be wanting rather than objectively trying to understand what Americans are all about.

Q. What about freedom of choice in health care? Isn’t that uniquely American?

A. There are three types of choice in health care.

First your choice of your preferred physician. But a single-payer system, for example, does not necessarily change that, since all the facilities and practices as we know them today are left in place. In fact, if you take away all the insurance restrictions we have today on whom you can see, your choice is increased.

second is the freedom to choose a health care plan. What people really want is a user-friendly system to get what they need.

Finally, third choice has to do with deciding on whatever tests and treatments you might want as a patient. [T]hose choices affect cost. [The]pendulum has swung toward patient autonomy — which is a good thing — doctors sometimes feel they must give patients whatever they want. That has led to a huge proportion of money being spent on care that is not only marginally beneficial but is also of no benefit at all. I think that if we had a way to eliminate that — which means using our clinical decision-making skills and saying no when appropriate — we would have more money to spend on care that does matter and that makes a difference.

No matter what system we ultimately decide upon, there will have to be mechanisms in place to insure that we spend money wisely.

Q. So is there anything that is uniquely “American” about our way of approaching health care?

A. Yes. We are unique almost worldwide in that we deny health care coverage to a proportion of our population. [T]he important thing is to get health care right and not to harp on the uniqueness of the system we come up with.

Q. How would you envision a health care system that is imbued with “American values”?

A. In virtually every opinion poll conducted in recent years, a majority of Americans favor government guaranteed health insurance. [T]hink of such a system as “Medicare for all.”

[T]here would be hard choices, and not everyone would be happy. But we might come closer than we are to representing the interests of most Americans.
Read the whole article here