Seminar to address ‘personal responsibility’ in health policy

Is health care a personal responsibility or society’s responsibility? Is it a private good or a public good? Those questions have grown more urgent as the U.S. struggles to contain medical costs and implement the Affordable Care Act.

Eric Wright, professor and director of the Center for Health Policy in the Fairbanks School of Public Health at IUPUI, argues there is no simple answer. Health care is complex, he says, and both individual and social responsibility come into play in providing care and allocating who pays for it.

Eric Wright

Eric Wright

Wright will lead a seminar this week on “The Promise and Pitfalls of ‘Personal Responsibility’ for Reforming our Healthcare System” at IU Bloomington’s Poynter Center for the Study of Ethics and American Institutions, 618 E. Third St. It will take place from 4 p.m. to 5:30 p.m. Thursday. An RSVP to eayoung@indiana.edu is appreciated, but walk-ins are welcome.

“The debate is usually framed as either-or,” Wright said. “Either society does it all, we have a ‘nanny state,’ or people are on their own and asked to pull themselves up by the bootstraps.” A better course, he said, would be “a multi-dimensional framework for making decisions about when we ask people to pay more for health care and when we don’t.”

Wright will discuss two research projects that he is conducting with graduate students. One is an analysis of what philosophers and ethicists say about the topic. The other is an examination of positions taken in media outlets such as newspaper editorials.

Proponents of personal responsibility argue that patients will use health care more responsibly if they have more “skin in the game” – that is, if they have to bear more of the cost and if they are penalized for making bad decisions. Others claim health care is a social responsibility and everyone benefits when people are able to get the care they need to stay healthy.

“What we’ve found is, there’s a good-sized chunk of people who say, ‘Well, it depends,’” Wright said. “What we’re trying to find out is, what should it depend on? And can you translate these ways of thinking into a framework for thinking about, for example, how to charge for certain treatments.”

The “elephant in the room,” Wright says, is uncertainty. We know certain behaviors – keeping active, eating well, avoiding tobacco, getting flu shots, etc. – will help keep us healthy. But there’s no guarantee they will keep us from getting sick, even catastrophically so.

Wright conceptualizes the issue as a chart with two intersecting axes, one expressing individual control of health outcomes and the other representing medical certainty. He says it may make sense to assign a heavy weight to personal responsibility for behaviors that we can control and that are certain to contribute to illness – for example, smoking, which causes lung cancer. But it makes less sense to hold individuals responsible for outcomes that can’t be predicted or prevented, such as Alzheimer’s disease.

Slides from an earlier version of Wright’s presentation, given at the University of Southern Indiana in Evansville, are posted online. Thursday’s talk is part of a monthly series of healthcare ethics seminars at the Poynter Center; a schedule is posted at the center’s website.

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