America’s Healthcare System Needs a Social Contract

As a citizen it’s easy to clamor for rights. It’s much harder to live up to our responsibilities. And so it is in health care.

As citizens we have implicitly agreed to abide by a social contract, which means a person’s moral and political obligations are dependent on an agreement among them to form the society in which they live. In other words, I am willing to “give up” certain things, such as complete freedom to do as I want, in exchange for which I gain the right to live in a protected society. 

Perhaps it’s time we begin to think of healthcare in much the same terms. When we as care providers walk into a room to see a patient we abide by certain principles. For example, we agree to use our medical knowledge and training to appropriately diagnose and treat the concern for which a patient presents to the emergency department. On the flip side, as a patient I agree to be treated and give an accurate history so an appropriate treatment plan may be made.

How does that translate to our healthcare system? As a consumer of health care I should try to consume as few of the system’s resources as possible by eating right, exercising regularly, not smoking and minimizing alcohol use. That is my responsibility. In exchange for living up to those responsibilities, my right is to have my disease treated appropriately with access to cost effective medications and therapies when needed.

Of course, our system doesn’t work like that now. Far from it. Our system of care as it stands is heavily weighted toward the treatment of acute conditions with less focus on preventative care, while many patients – often the ones that show up repeatedly in emergency rooms – neglect responsibility for their own health until it is too late. The end result is a high expenditure of care to treat disease at its most costly point, only after that disease has been years in the making.

Again, it’s easy to clamor for rights. It’s much harder to live up to our responsibilities.

If our healthcare system is to transform into something better then we each have a role to play. We all need to consider whether we are living up to our own responsibilities in this social contract. We then have to speak with our own families regarding hard decisions on choices, use of health care resources, palliative and end of life care.

As emergency care providers we see the best and the worst of our system. We have the privilege to treat patients at some of the most vulnerable times in their lives. The compassion we embody at the bedside allows us the opportunity to have these most difficult conversations. We have both a right and responsibility to have them in order to make our system better for our patients and ourselves.