A rational approach to health care requires the presence of a knowledgeable patient “in the driver’s seat” who has the financial responsibility an power for the process. This is exactly what the Health Savings Account (HSA) concept is all about. It is the patient who makes the determinations regarding expenditure of resources and does so on a risk vs. benefit basis.
In an HSA would a patient with breast cancer invest their $250,000.00 in a bone marrow transplant? Given the present science this person might choose other alternative therapies. The key to all of this is that it is the patient (not an uninterested third party) would direct the decisions.A rational approach to health care also requires providing the patient with a bodyguard of understanding about true disease and disability prevention and the means of adequate recourse when harm is done. Inherent in all of this is providing patients with adequate “firewalls” to protect personal privacy, appropriate patient “rights” and protection against catastrophic events. In the new era of genomic (hereditary) informatics patient’s require secure protection of their health care records to avoid misuse of this important information.
Providing patients with true independence in health care is not yet something which has gained political muscle although some enlightened commentary on the subject has being advanced. The legitimate fear produced by allowing the continuation of managed care is that its perpetuation will lead the United States to the folly of emulating a universal, British/ Canadian-type health care system rather than adapt a more sensible approach.
In the aftermath of September 11, 2001 and related events we have been forced as American citizens to re-examine many important things which had been placed on back-burners. The issue of Ethics can not be taken for granted. Consideration of the Ethics of Spine Care is a good place to start. More rational paradigms of utilizing, and not destroying, strengths of the medical establishment need to be addressed.