by Daniel Johnson and Robert Moffit
Millions of dollars are being spent on pursuing ‘equity’ in our healthcare system while insisting that we do not have “equity” because our entire medical enterprise is systemically racist. To get there, some even suggest that we should prioritize care delivery by skin color.
This approach is problematic. It creates racial division. It also conflicts with the overarching goal of medicine, which is to provide the appropriate care in the appropriate setting at the appropriate time when a patient presents with illness or injury, with emphasis on preventing illness or injury whenever possible.
In an era when we already have so much division and rancor, here’s an idea: Why not just agree to concentrate on delivering the highest level of medical care to each patient, regardless of racial, ethnic, or other characteristics?
The terms equity, equality and parity each mean different things to different people. Yet, all three share a common objective: fairness. Instead of promoting divisive and discriminatory demands, wouldn’t we do better to rally around and focus on fairness? In healthcare, simple fairness and color-blindness are both desirable and realistic.
Rather than exploiting racial division, a patient centered approach is aspirational and seeks to achieve true fairness by creating unity of purpose. The advantages are many, and the downsides are virtually non-existent.
The relationships most critical to achieving health system fairness are the patient-physician relationship, the collegial relationship among physicians and other members of a healthcare team, and the relationship between the patient and the health care system.
A patient-centered approach eschews divisive ideology. It is a positive, aspirational approach that seeks to achieve true fairness by building up, not diminishing.
The three pillars of a patient-centered approach to providing access to high quality care at sustainable cost are 1) expanded personal choice, 2) personal selection of health care arrangements and ownership of health insurance policies, and 3) fairness in the provision of any government subsidies for health coverage and the federal tax treatment of health insurance.
Rather than assume that patients are incapable of making informed health care decisions for themselves, the patient-centered approach assumes they can. There are multiple possible methods to finance and deliver high-quality care. Why not put them in competition with one another and let the patient choose which method works best for them?
Giving individuals the opportunity and the responsibility to choose and own their health care arrangements and insurance—with the periodic chance to change if they become dissatisfied with their selections—assures personal control and portability. And, by definition, health plans and others in the health care sector would be directly accountable to the patient.
When buying health insurance, virtually all Americans receive some financial assistance, be it tax-free coverage at the workplace, some level of government subsidy or some benevolent charity. That assistance should be the same regardless of racial, ethnic or other characteristics. That is fairness.
Various non-health related factors, including housing and transportation, but especially education, can contribute to disparities in access to health care. These factors are very real, and specific remedies must be applied through sound social and economic policies.
For example, getting students of all backgrounds out of failing schools through school choice should be a top priority for state and local policymakers interested in promoting fairness.
High quality K-12 education directed at giving graduates the knowledge to find and hold a job or to pursue higher education will enable the students to prosper rather than be consigned to a life of poverty and reduced social and economic expectations and accomplishments.
In the practice of medicine, to achieve a sustainable health system, medical professionals must focus on identifying health disparities and support research on how they can be eliminated.
Medical education is justifiably focused on excellence. No one wants their doctor to have received the MD or DO degree as a “participation award.” Your doctor should continue to be incentivized to get the best training and lifelong continuing medical education possible for the chosen type of practice. Meritocracy in medicine is not a myth.
Likewise, the delivery of care needs to be of the highest quality possible for the medical condition at hand. The physician is ethically responsible to see that that occurs. It is not a zero-sum game with winners and losers.
Education and healthcare are intertwined. Promoting personal choice and defined-contribution financing offers the same advantages in education reform as in health system reform. When the accountability flows to the student and the beneficiary, the cost goes down, the quality goes up, disparities are reduced, and health care is enhanced.
Fairness: Everyone benefits.
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Daniel Johnson, Jr, M.D., is a diagnostic radiologist in Metairie, La., and a former president of the Louisiana State Medical Society. Robert Moffit, Ph.D., is a senior research fellow in The Heritage Foundation’s Center for Health and Welfare Policy.
