Healthcare Reform: The 'forgotten factor"

It is no secret that I firmly believe that we need TRUE and REAL healthcare reform in this nation. I have many friends who are medical professionals (most of them very, very conservative in their thinking) who believe that we are YEARS behind where we should be in reforming our healthcare systems in this country.

But there is ONE factor that hasn't come up in the debate: Personal responsibility.

As I stated somewhere else (can't remember exactly where), NO HEALTHCARE REFORM will be effective, lasting, or worthwhile if the mindset of the "American consumer" is not considerably altered in how and why and when they access their "health care" options.

Example: My mother is a chain smoker. Has been all of my life, and I suspect YEARS before I was ever born. Her personal physician has warned her for years that the cigarettes would eventually kill her. She has suffered with many, many health problems--directly related to her nicotine habit. She REFUSES to stop smoking. Yet, she is seeing her doctor all the time to see how he can medicate her for various breathing/health ailments--all related to her cigarette smoking and self-abuse of her own health for more than four decades. Where does the insurance company, and the primary care physician say, "We aren't going to spend our resources on this patient who refuses to take responsibility for her own health"?

Example: I am preparing to be a kidney donor for a wonderful, wonderful friend who desperately needs a transplant. The surgical team performing the procedures have basically already given me instructions for "after-care" and what I can expect once my left kidney has been removed from my body and transplanted into the recipient. What if I completely IGNORE the advice and warnings and instructions...and later run into SEVERE medical/health problems because I didn't follow "medical instructions"? What kind of obligations does my health insurer have to me in this case? What repercussions must I assume, since I am the one deliberately not following professional, medical instructions after major surgery?

Example: I have worked in two separate medical facilities (smaller hospitals) in two very different settings (Cleveland, TN and Chicago, IL) as an Emergency Room Clerk, and on a medical-surgical ward. I've seen all the "repeat offenders" coming through both departments of the respective hospitals. Most of these people have some type of insurance--either private insurance, or one of the "public options" (Medicare, Medicaid, or Public Aid) that is already in place in both states. Ninety-Nine percent of these patients who present themselves to the Emergency Room(s) do so late at night, on a weekend, when their primary physician(s) are normally on call, or out of reach. Most of these situations are not "emergency" fact, most of these people refuse to see their own primary care physician, for whatever reason.

I remember one such person, who had just been discharged from the hospital in Tennessee, and about 20 minutes later was in the Walgreen Parking lot smoking a joint that someone had brought to him when they picked him up from the hospital. Later that night he was b ack in the Emergency Room of Bradley Memorial Hospital....complaining of severe breathing problems. What should be done in this case?

The forgotten factor, in my considered opinion, in this whole debate is how the American consumer should adjust to accessing their health care systems once the reforms have been passed and enacted. There is WIDESPREAD abuse in the health care systems, simply because NO ONE is being held accountable for abusing the consumption of services, unnecessarily.

This is the forgotten factor...the 8000 lb elephant in the room. He's not going anywhere as long as he's being ignored. Someone must realize he is there.

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