What responsibility?

Richard Pettingill is right on in his commentary (“More access isn’t enough,” March 16, p. 18), especially in regard to suggesting that health promotion be one of his “six areas of initial focus.”

I have long been frustrated that liberal Democrats—like those in the current administration—believe that we actually have a formal “healthcare system,” and that the solution is to plow taxpayer money in to “fix” it.

The “fix” really needs to be a wholesale and complete change in the personal health philosophy of every American. That is, fixing healthcare needs to start with improved individual health literacy, and each of us taking responsibility—and being held accountable for—our health and wellness. As Americans, we want 100% freedom to do what we want to our bodies, but accept 0% responsibility when it comes to the prevention or cure of what we allowed to happen because of that freedom. We don’t want to be told what to do, yet we look to the government to take care of us.

Almost 50% of our children are overweight or obese. Many Americans overeat, smoke, drink and lead a sedentary lifestyle that leads them directly to the doctor’s office, the emergency room or worse: an early grave. If we are serious about “fixing” healthcare in America let me offer my own suggestions as a start:

Ban the cultivation, sale and use of tobacco—in lieu of that move, then tax smokers at a higher rate to offset the costs of their (government-funded) chronic care.

Mandate every school child to have two hours of exercise a day—as part of school curriculum.

Instead of requiring employers to offer health insurance as a benefit, mandate that all employers make their employees exercise vigorously for an hour a day.

People who don’t wear seat belts should lose the privilege of driving for at least six months: It’s cheaper than trauma care or a funeral.

All restaurants should provide nutritional information to all customers.

Alcohol should contain nutritional information, be heavily taxed or banned.

These are just a few of the many things that we need to be looking at before we can even consider dumping trillions of dollars into a nonsystem that, in the words of J.D. Kleinke, is in fact a “hodgepodge of historic legacies, philosophical conflicts and competing economic schemes. Healthcare in America combines the tortured, politicized complexities of the U.S. tax code with a cacophony of intractable political, cultural and religious debates about personal rights and responsibilities.” (From Oxymorons: The Myth of a U.S. Health Care System).

I can’t help but think that after the subprime mortgage meltdown, the credit meltdown and the auto-manufacturer meltdown, that we are now staring at a U.S. health and wellness crisis of such magnitude that we’ll surely break the resources of the nation within four decades of the first baby boomers reaching 65 in 2011.

Mark Lisa

CEO Doctors Hospital Manteca (Calif.)

I enjoyed reading “Raising the bar for boards” (March 2, p. 6) and viewing the accompanying interview with Marie Sinioris (www.modern healthcare.com/section/videos).

Your readers should also be informed about other regional governance education efforts such as the Governance Briefings presented by the Health Policy Institute at the University of Pittsburgh’s Graduate School of Public Health.

For the past 10 years, national and regional leaders have provided six briefings per year that focus on board roles and responsibilities.

These seminars have been free of charge thanks to funding from regional providers, insurers, foundations and law firms. The current program schedule and videos of past briefings may be viewed on www.healthpolicy institute.pitt.edu.

Samuel A. Friede

Director, governance initiative Health Policy Institute Graduate School of Public Health University of Pittsburgh

Comparative-effectiveness research offers an opportunity to evaluate government policy (“HHS chooses comparative-effectiveness panelists,” Daily Dose, March 19). Perhaps we can subject policies such as “never event” determinations to scientific review.

A recent Journal of the American Medical Association commentary presents an example of the unintended consequences of their policymaking. Deep-vein thrombosis after these procedures is biologically unavoidable even with evidence-based therapy and patient compliance.

Clinicians and hospitals will avoid high-risk patients (obese) and this particular procedure all together. They could attempt to lower the likelihood of avoiding a venous thromboembolism, or VTE, event of excessive prophylaxis (with increased bleeding complications, which is not a “never event”). Finally, this policy affects only 8.6% of the currently recognized deep-vein thrombosis events post-discharge or procedure and does not set expectations for the other 93% of admissions at risk. The authors observe, “The Joint Commission has recommended that hospitals adopt procedures to ensure that all patients receive risk-appropriate VTE prophylaxis within 24 hours of hospital admission or within 24 hours of transfer to the intensive-care unit.”

It is the process, not the outcome, that can be the true measure in this case. The CMS policy should be subjected to the same “comparative effectiveness” standards as practicing clinicians. The CMS should lead by example.

R. Bruce Wellman, M.D.

President and CEO Carle Clinic Urbana, Ill.

What do you think?

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