Members of the US Congress,

Thank you for the opportunity to address you as part of the debate on the critical role of health care reform in our country. My name is Randale Sechrest. I am a physician would like to express my support for a health policy that guarantees every citizen the right to health care.

The preamble of the Constitution of the United States states:

“We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.”

This statement establishes that from the beginning the United States was created with the understanding that the role of government is not restricted to the provision of security and protection of liberty, but also includes the obligation to address the welfare of each and every citizen in a just and equitable fashion. Subsequent amendments to the Constitution have confirmed that these benefits are inclusive and are to be applied to all citizens: Amendment 13 through the abolition of slavery, Amendment 15 by confirming the right to vote by African Americans and Amendment 19 by extending the right to vote to women. These and the other amendments to the Constitution establish that we also recognize the need to adapt as the interests we share in common change in order to better provide for the general welfare of our citizens and guarantee justice.

Health is a critical asset to every person. Health status has a profound effect on the pursuit of nearly all other attributes that an individual values. Insufficient health status can result in unnecessary suffering and mortality, but also has effects on personal autonomy, economic opportunity and self actualization. In order for each individual to achieve and maintain a sufficient level of health status, we must ensure that our public health system is robust enough to recognize and protect our citizens from threats to their health and our health delivery system is accessible to all for both preventative care and treatment of injury and disease.

The complexity, as well as the benefits our health care system can deliver has drastically changed in the two centuries since the Constitution was written. While some individuals may lead a healthy life that requires minimal interaction with the modern health care system, the important role that formal health care plays in most of our lives today is indisputable. The vast majority of the population will need to take advantage of the health care system at some point in order to resolve or manage a critical life issue. The success that our health care system has enjoyed in both resolving and managing these critical life issues has increased the importance of health care in our lives in the last 100 years. Likewise, the consequences of inadequate health care have resulted in a growing chasm between those that have access and those that do not – not only in health status, but in socioeconomic status as well.

The burden of disease and injury is unevenly distributed. The presence of health and disease are determined by an unknown number of variables that none of us can comprehend, much less control. For some, it is clear that some combination of socioeconomic status, race, genetics, behavior and random luck have conspired to place us at a disadvantage and threaten our health status. For many others, we simply have not realized that we, too, are at risk – either through some unfortunate accident or simply though the ravages of time and old age. None of us can eliminate the risk of finding ourselves in need of resources beyond our capacities.

Health status is as important as any other social good. In the same way that our society has evolved to realize that all citizens are entitled to share the privileges and rights elaborated in the Constitution, we must also recognize that health status is now included in this set of rights and privileges. Any meaningful plan of health care reform must provide universal coverage and guarantee access to health care for every citizen of the United States.

Thank you,

Randale C. Sechrest, MD

Our health care system is in crisis.

47 million citizens have no health insurance. An untold number of citizens with insurance quickly find themselves underinsured if they must use their insurance. Together, these two groups represent a population at increased risk of reduced health status, increased mortality and financial devastation.

The cost of health care continues to rise. Left unchecked, the rising cost of health care will increase our national budget deficit, reduce our ability to compete economically in the global marketplace and make health care unaffordable for more and more citizens.

Our current health care system is both unfair and unsustainable.

The vast majority of the civilized, developed nations of the world consider health care an essential human right. This list includes Canada, France, Britain, Ireland, Sweden, Norway, Germany, Denmark, Japan, New Zealand, Australia, Austria, Taiwan, Switzerland and the Netherlands. The United States is unique among all the industrialized nations of the world in that it does not provide universal health care to its citizens.

As health care reform debate continues, the path to a solution grows murky; the real issues obscured by rhetoric, misinformation and downright fear-mongering. We have been overwhelmed with details (perhaps intentionally) – details that tend to obscure the core issues.

One key question before each and every citizen of the United States is clear: “What does the United States consider health care – a market commodity or a basic human right?” The acceptable solutions become radically different once we decide the answer to this key question.

As a health care provider, I believe that the United States needs to join the vast majority of the developed world and recognize that health care is an essential human right.

I believe that the United States needs to enact real, meaningful health care reform that moves toward achieving a goal of universal coverage of each and every citizen of the United States.

I have listened to the arguments that would portray “good health” as merely a lifestyle choice that is within the grasp of each and every individual – if only we exercised the appropriate personal responsibility. But, that is an illusion. While personal responsibility indeed plays a role in improving one’s chances of leading a healthy life, the reality is that none of us can predict if and when we will be stricken – through no fault of our own – with an unforeseen injury or illness that can devastate us and our families. We all stand to benefit from the security of knowing that we will have health care when we need it.

While there may be many ways to achieve meaningful reform, controlling the cost of health care must be a centerpiece of any effective strategy that aims to create a sustainable health care system. Health care decisions must be made based on scientific evidence. Health care cannot continue to be perceived as a market commodity that is rationed by purchasing power and driven by the perverse incentives that characterize the current broken system. Health care is a public good and the health care delivery system must be retooled to recognize and reflect the critical role that health care plays in the security and well being of our society.

I believe that our country will be more productive, our businesses stronger and all of our futures brighter if every citizen is secure in knowing that he or she has access to quality and affordable health care and will not be financially devastated by a medical calamity beyond our control.

I am dismayed by the misinformation and fear tactics that have been used by those who stand to benefit from a continuation of the status quo – a health care system driven by the profit motive rather than the humanistic ideals of compassion and professional obligation. The rhetoric is designed to confuse and cloud the core decision that faces our country today as we call the question: “Will we join the rest of the civilized world and work together to provide all of our citizens health care security as a right of citizenship – or not?”

Randale C. Sechrest, MD

This is an incredible demonstration of the value of narrative in understanding complex cultural transitions that are brought about by changes in science. The project also demonstrates the power of using multimedia (in multiple forms), combining that with the value of live interactions inherent in creating an “event” and then using the distributive power of the Internet to make all of this content “persistent” such that the value continues to build over time.

The website can be accessed here.

I recently finished “The Future of Bioethics” by Howard Brody, MD, PhD. Dr. Brody took the helm at the University of Texas Medical Branch as Director for the Institute for the Medical Humanities in 2006. This book could be termed “the rest of the story” in bioethics. The book takes a very serious look at issues that have NOT necessarily been on the forefront of medical and bioethics discussion over the past decade as the discipline has grappled with high profile – and high tech – issues such as the nanotechnology and human cloning. Rather, this volume brings the focus of bioethics back to the basics and asks: “What is the role of the bioethicist in speaking for the disenfranchised, the poor and the disabled?”

I was particularly pleased to see an entire chapter devoted to the intersection of bioethics, the environment and sustainability. We may face no greater threat to our well-being during this century than environmental destruction. It is high time that we look at this as an ethical issue and worthy of attention from the medical community at large. Bravo.

This is an inquiry into social justice at its best. Get it, read it.

Randale

I ran across this video of a talk that David Brooks gave at the Alpine Institute. It literally changed my entire perception of Mr. Brooks as well as crystalized some of those nagging uncertainties that constantly inform my day to day existence. This is a very well thought out discussion and I look formward to the upcoming book that he is preparing that deals with these issues. Nothing is as it seems.

Anyone interested in the future of the food supply should visit the Slow Food Nation website and browse the videos available from the conference held in San Francisco in the Fall of 2008. The video below outlines the current crisis in the global food supply and outlines the issues clearly and succinctly.

It is readily apparent that chronic disease management requires a different paradigm than the traditional approach of “reacting” to episodic illness. Self care requires access to accurate, easily accessible and understandable “actionable information”. Rich information resources that provide real value to healthcare consumers looking to assume responsibility of managing their own health situation will become more valuable to the “system” as a whole.

Currently, the vast majority of healthcare information produced for consumption is designed to drive consumption of healthcare services.

Why?

Because that is the primary way that the costs of creating and distributing healthcare information results in a demonstrable return on investment. The healthcare system views the activity of creating and distributing information as equivalalent to advertising. This dynamic is slowly beginning to change.

Those parties that are at increased economic risk in the current health care paradigm may well choose to shift their focus to more self care, trying to avoid costly interactions with the health care “system”. This means that patients will begin to look for ways to effectively self manage much of their chronic care as they are forced to bear more of the costs. Likewise, payers at risk will look to encourage providers who offer ways to empower patients to more effective at self care.

Information that is designed to create awareness of the potential benefits of specific behaviors and disease management techniques – and then guide a patient through the steps necessary to achieve the desired behavioral change can empower and, ultimately, lead to the patient assuming increased responsibility. Facilitating this dynamic may enable improved self care and become increasingly important in improving outcomes and reducing costly interactions with the “system”.

Accessing the “system” for a one-on-one consultation to transfer this information is much too costly. But, in the current paradigm, a cascade of these sort of consultative interactions is the primary mechanism to try and create the necessary behaviors to self manage chronic disease. The patient is seldom provided easily accessible and effective “self serve” information tools necessary to create true empowerment. Why? Because the cost of creating these assets is not directly reimbursed.

Creating and distributing information does not create direct revenue for the organization (for example, a hospital) – this function is a cost center under the current paradigm. The benefits accrue indirectly from the marketing benefit – driving the fee for service offerings and increasing the utilization of these services.

Our current approach to creating and distributing information just worsens the real problem – it actually is all geared toward increasing demand for the fee for service aspects of health care delivery. We give people only enough information to entice them through the door to initiate an extremely costly cascade of interactions with the health care system. We do not create information resources that are designed to address the real problem – i.e. we do not educate and empower patients to self manage, nor do we design information assets that are designed to allow patients to prudently and effectively access and utilize the resources of the health care system. No one compensates this activity. Instead, we market our products.

But what if the paradigm shifts to optimizing population health? What if instead of a being in the business of selling a “healthcare product”, we are charged with fulfilling a “healthcare obligation” on a finite budget?

All of a sudden, we are in the business of creating a much different relationship with the patient – one where it is in our best interests to help the patient be successful at self management. Enabling patients to understand how to effectively and efficiently ACCESS care will become critical. Creating and distributing the information necessary to make actionable decisions about when and where to access the regional healthcare “system” will become as critical as providing the technical service.

Cost containment, by reducing the need for the patient to access the healthcare system for the technical service, will have a real value.