Individual responsibility for health care

‘”The internet has changed people’s relationships with information,” writes the invaluable Susannah Fox at the Pew Internet and American Life Project, in a new report about the social life of health information. ‘Our data consistently show that doctors, nurses, and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the U.S.”

There’s a wealth of interesting information here, including the report (based on a survey of more than 3,000 adults last autumn) that only a handful of people rate doctors and hospitals on web sites, but an enormous number (80 percent of internet users) look for health information online, including 34 percent who have read someone else’s commentary or report about medical information online. The numbers are surging, showing a real interest by real people in using the Web to manage health issues. Social media and sharing are on the rise.

” ‘I know and I want to share my knowledge’ is the leading edge of health care,” she writes.

If we take a sharp right, we find another, less flattering opinion about choices made by the American people about health care. Dr. Cecil Wilson of the American Medical Association writes in an opinion piece on kevinmd.com that the choice to be uninsured is harmful to society as a whole, suggesting somehow that the uninsured (who now number 50 million) are actively not interested in investing in their own health.

“Those who choose to be uninsured, exempting themselves from the risk pool, often place the responsibility of paying for their health care on the shoulders of others. If they are faced with a serious illness or accident, they risk bankruptcy. … If they can’t pay their bill, the cost of their care is shifted to others. The result: higher costs for everyone.”

I disagree with Dr. Wilson over the idea that people choose to be uninsured. He writes that the AMA has long supported “individual responsibility to purchase health insurance for those who can afford it and subsidies for those who can’t to help remedy this situation.” Promoting “individual responsibility” is a centerpiece of his thinking.

Since I’ve been examining the health-care marketplace in New York, it’s become apparent that the exhortations to individual responsibility are somewhat hollow here. The plans available to people who aren’t covered by their employers are wildly expensive and come with all sorts of exclusions and exceptions, even for people who are young and healthy. This would be no surprise to anyone who’s rubbed elbows with the 20- and 30-something population of the New York metropolitan area, half of whom are uninsured or underinsured.

My own insurance premiums costs $1,889.36 a month for my family. That approaches my mortgage payment. That is not affordable in any sense.

Opportunities to make meaningful health care available to the uninsured or to anyone else were lost in the health-care act debate. That act made universal insurance coverage a goal, but removed the public option from the table–meaning that insurers get help in getting more business, providers get help in receiving money for their services, and individuals get little help from anybody on affordability.

It would be good to hear from Dr. Wilson explaining what his organization is doing to create meaningful subsidies or other aid for people who cannot afford insurance–or for those who can only barely afford it.