How the consumer focus has changed medicine...

At our local hospital, as perhaps in most all hospitals today, the focus is on the patient as a health care consumer and the success of the hospital is tied to consumer satisfaction.  Given that the health care provider is a matter of choice it might be understandable but I am not so sure that we have fully considered the consequences of consumer medicine.  Many, if not most, are in the hospital not as an exercise of choice for an elective procedure but out of need, a good share for the sake of a life or death issue.  What is the consumer response to the bad news that hospitals and health care professionals must deliver daily to people who do not wish to hear it?  It is hard to be positive about the hospital stay when the diagnosis is terminal.

In the December 2012 issue of First Things, Wesley J. Smith has addressed this same issue from the perspective of the confusion between legitimate medical procedures born of health care needs and the choices made by patients as consumers of medical services.  His words are even more urgent as our nation establishes the rules and definitions of what constitutes basic health care needs and services which are essential and those which are deemed non-essential (and, therefore, not covered).

Smith maintains that basic health care has increasingly shifted to include coverage for medicines, treatments, and procedures which are not necessarily medical in nature or reflective of real or urgent health care needs.  His list includes:

• Botox treatments, facelifts, collagen injections, and other cosmetic related therapies and surgeries that do not treat pathologies but address psychological issues, self-esteem issues, or quality of life issues...
• Reproductive services which are not born of infertility but the result of lifestyles and life choices -- from IVF for gays/lesbians who have no potential for conception without them, single women who choose not to conceive by sexual intercourse, or women who desire to conceive past menopause...
• Abortions as elective procedures use for birth control purposes, for specific gender or physical characteristic selection, or other non-emergency need...
• I would add the cost of contraception because unfettered "safe" sexual activity has become a basic human right among some (the Sandra Fluke issue of a "right" to free birth control because of a choice to be sexually active)...

His point is well taken.  Much of what we spend our health care dollars on are not maladies but personal choice and lifestyle consequences, self-esteem issues, and goals or desires unrelated to actual physical health.  The more we spend on these consumer choices, the more limits we must place on other expenditures for actual medical necessity -- especially high cost procedures such as organ transplants.  This is already the way it is in nationalized health care programs such as England and Canada.  Somebody has to pick and choose what will be covered and what will not, what constitutes basic health care and what is not.  That will have to happen here in an even more urgent way and who will drive these decisions?

While Smith is addressing this from a cost and culture perspective, I would turn the discussion to the issues of values and choices -- in particular the values and choices of Christians who are greatly tempted to blur the lines between choice and necessity.  Have we as Christians contributed to or even furthered the muddy waters surrounding this issue?  Have we left our values to our lips while our hearts seek after the same access and low cost venues for consumer medicine as everyone else?

It would seem to me that this is exactly the point.  The dust up over the ELCA health insurance coverage of abortions without question is germane here.  As a Church and as Christians, we should not get swept up in the move to make medicine and medical choice into a consumer issue.  Physicians and nurses and other health care professionals may provide a service to us but that service is distinctly different and of a different value than those who serve our other needs and desires.

Do no harm has become what can we do to please you... No society can cover the cost of such a consuming demand and desire will erode our values until pleasure claims more than the health care industry....