The recent federal court ruling that the Obama health reform bill is unconstitutional—due to its mandate that individuals must purchase health insurance—reminds me of a seminar on personal health records I attended several years ago. The speaker, a physician who was running a PHR software company, was asked if the technology would have any impact on health outcomes. His answer: Americans are in denial about their own health. He cited the rising incidence of obesity (which has since grown even more dramatically), the corresponding spread of expensive chronic diseases, and the overall reluctance of many people to take responsibility for their own health, PHRs or no.

There’s no telling how the courts may ultimately rule on the reform law. But I have no problem with the government telling us we need an ownership stake in health insurance. We have become so disassociated from the economic reality of paying for care that we take health care services for granted. We are fast becoming a nation that wants to eat, drink, smoke, snort and inject itself into oblivion, without regard for the fiscal fall-out—let alone regard for our bodies.
 
To me, owning health insurance—and trying to keep my own health in good order—fall under the category of responsible civic behavior. Conservatives have argued that compelling people to buy health insurance sets the stage for compelling them to do just about anything. To them, the “nanny state” lurks ominously. But who among us can legitimately claim they will never use health care services?

And while I respect conservatives for seeking to preserve our liberties, I’d like to suggest that every freedom comes with a corresponding responsibility. This “individual liberty” argument surfaces every time some “intrusive” law is suggested. The liberty lobby fought long and hard, for example, against mandatory helmet laws for motorcycle riders. Well, who do you think pays when these aforementioned riders crash their bikes and wind up in the E.D.?

Invariably, the direct costs get passed along, dispersed to a broader group of patients whose commercial insurance plans feed the ever-squeezed hospital kitty. And the indirect costs to society of lost creativity and productivity are all but immeasurable.

Now don’t get me wrong, I’m not a big fan of “ObamaCare,” and was disappointed by the almost total lack of bipartisanship that went into the law. And the very idea of enforcing any mandate gives great pause. But you have to start somewhere, and if this law is thrown out on the basis of the mandate, and Americans are off the hook for participating in health insurance, I’m afraid our state of economic denial will only deepen.

You could make the same argument and overturn the “meaningful use” EHR incentive program. After all, why should the government be able to tell hospitals and physicians that a) they have to buy EHR software, and b) they can only buy software from firms on a government-approved list? How intrusive can you get? Well, truth be told, the government—meaning us—has a vested interest in making sure that the latest tools are used in the delivery of care. So why should it pay top dollar for services informed by outdated tools (like faxes and paper charts)? And why should it pay for sub-par outcomes? To date, Congress has been remarkably bi-partisan when it comes to supporting the recent health I.T. incentives. No one waves the flag of constitutional theory in opposition.

I only hope that the court (and lawmakers on both sides of the aisle) will have the wisdom to understand that our current state of runaway health costs is driven—at least in part—by the lack of financial and health behavior responsibility from patients. And even a small stake in a health plan might increase the sense of ownership among the public for better health outcomes. The courts may indeed wind up gutting the reform effort. But they will not be able to so easily dismiss the serious problems that spawned it in the first place.

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