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Thursday, January 28, 2010

Rights and Consequences

“Americans for Responsible Health Care is dedicated to protecting the right to choose your own doctor, the right to the procedure you need at the time and place of your choice.”

That statement was part of the organization’s full-page ad in the January 21 issue of The Boston Globe thanking the voters of Massachusetts and congratulating Scott Brown on his election to the U.S. Senate.

Statements like that sound good, but they hide some important truths. For example, “the right to choose your own doctor” also means that your insurance company has to pay whatever doctor you choose, regardless of competence or efficiency of practice. It also greatly weakens the hand of anyone negotiating with the doctor on financial or clinical matters.

Claiming the “right to the procedure you need” raises another issue. “Need” is a value judgment and the question is, who will make it? Shall it be left solely to the doctor and the patient without regard to the source of funds to pay for it? The “right to the procedure you need” as defined by the patient and the doctor is arguably one of the causes of the high cost of care.

Then there is the right to get procedures “at the time and place of your choice.” For myself, I would like all the procedures I need to be available in the local village center, a three-minute drive from my house. And I’d like all my appointments to be at 9:00 a.m. Obviously, that is not practical.

If the cost of health care is to be brought under control, and if significant progress is to be made on quality, someone has to be responsible for doing it and accountable for results. It will not do to bind the hands of that someone by imposing “rights” without regard to their consequences.

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