Chris T. Pernell
Doctor and Clergywoman

Chris T. Pernell

Chris T. Pernell is a doctor and an ordained clergywoman in New Jersey. Two of her recent projects include a prison-based wellness program and a faith-based childhood obesity initiative.

In Pursuit of Good Health

We're all in pursuit of something. Everyone has an agenda, a bottom line. The health reform debate is no different. Many perspectives, interests and lobbies compete for a seat at the table. Against this backdrop, individual mandates may matter in securing passage of ambitious legislation, using the lure of new customers as a way to entice formerly reticent parties.

But what is ultimately achieved? Expanded insurance rolls. Check. A precipitous drop in the number of uninsured. Check. But what of controlling health-care costs? What of prioritizing quality care or wellness strategies? Unchecked. This leaves the question: are we in search of good health, good health care or good health insurance? Good health involves mind, body, soul balance. Good health care reinforces healthy lifestyles, prevention and curative treatments above disease management. Good health insurance on the other hand, speaks to access, affordability and choice benefits. Three distinct entities, each accomplished by differing means, yet each apropos in the quest to overhaul our current health system.

Like insomniacs crave better sleep habits, dentists urge routine oral care in promotion of total health and mothers laud the merits of personal hygiene, so too health care must be predicated on good health behaviors. This necessitates the question: do individual mandates foster a culture of good health hygiene? Mandates work on the threat principle: purchase insurance or pay fines and suffer penalties. But just like the death penalty has not deterred crime, individual mandates will not make us a healthier nation necessarily, rather a more insured nation. Nor do these mandates regulate the insurance industry and yield a better product. More importantly, individual mandates will do little to stem the exorbitant costs incurred in the pursuit of healthy living. Proponents argue to enroll more of the healthy will defray risk across the insured pool, making us all less vulnerable. Detractors, however, point to wasteful administrative expenses and additional bureaucracies as part of the unaddressed concerns.

Let's be candid. Individual mandates operate on the premise that the uninsured will be forced to buy health insurance because of a value issue. Where before high insurance premiums out-priced potential health benefits, instead burdensome fines would make the financial sacrifice more compelling. Even so, all will not be covered. For some, mandated insurance will still be too expensive. For this lot, rigorous hardship exclusions will be required. And what type of plans will satisfy the law? What will qualify as minimally acceptable health insurance? With so many questions unanswered, good health may remain the domain of the privileged few. Hence, it is uncertain personal mandates will deliver true reform.

Unfortunately, in the push for progressive yet palatable health-care legislation, individual mandates will remain on the table, possibly as bait but hopefully not to the exclusion of employer-provided coverage, honest regulation of the insurance industry, a robust public option, wellness initiatives, and advances in health information technology. We should focus on inextricably tying affordable care with quality care and the prized goal of wellbeing.

By Chris T. Pernell  |  July 7, 2009; 1:56 PM ET  | Category:  Insurance Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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Thanks for the feedback. As for the death penalty analogy it is quite apropos because proponents of the death penalty in part argue that the threat of a death sentence will deter potential criminals from certain crimes but it has not been proven that people commit less offensive crimes in death penalty states. To speak to the death penalty as retribution is a different matter however.

As such, just because we make an individual mandate to purchase health insurance does not translate into someone adopting healthy behaviors and attaining good health. Plenty of patients who do have insurance remain unhealthy and unwell. The analogy serves to show that like other laws that did not prevent certain actions neither will this law.

Thanks again and as always let's continue the dialgoue!

Posted by: chrispernell | July 11, 2009 10:33 PM
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I definitely agree strongly with you argument on the emphasis of personal responsibility with regards to our health care (it SHOULD be a personal issue first and foremost so that drastic health care procedures can be preempted)...but the analogy to the death penalty really isn't apt.
With regards to that, it's usually all or nothing: you commit one heinous murder in the "right" state and you could face death row. With personal hygiene though, it's really more of a process that involves little life changes and steps towards the overall betterment of the physical condition. Sure a one-time action like riding your bike without a helmet or falling off a horse can have disastrous consequences and put you on "death row", so to speak, but that's ALSO the issue with health care: those situations couldn't necessarily have been predicted and they WEREN'T intentional like the murder, say, of a police officer.

Posted by: Medstudent1106 | July 10, 2009 12:00 PM
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This is an excellent article. I believe it is a balancing act when it comes to reforming health care and I agree that the answer is not mandates. If wellbeing were the goal for all parties involved then it would require a certain amount of sacrifice for each side but, with the goals being more self centered I believe that is why the struggle is so great. That's for the post!

Posted by: prophetessjnc | July 8, 2009 7:23 AM
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