CHRTlines

November 17, 2009

What’s a person to do?

Marianne Udow-Phillips

Director
Center for Healthcare Research & Transformation

“Breast-screening advice is Upended” (Wall Street Journal, November 17, 2009)

For years, we have been told that we should have a mammogram every year after age 40 and in 2002, this advice was repeated by the same folks who now are recommending that most women can wait until 50 for routine mammograms. Does it make anyone think about the margarine vs. butter debate? I don’t want to debate the merit of these new guidelines – that’s another topic that has generated a lot of buzz in the blogosphere. Rather, I think this change in guidelines is illustrative of an important issue related to health reform: what is the role of each of us as consumers of health care?

When some health reformers talk about the need for personal responsibility in health care, they sometimes liken it to the way an informed consumer should take care of their car. But, I am sorry, I think we know a lot more about when and how we need to change the oil in our car engines than we know about the way the body works and what works best in taking care of ourselves. Yes, there are some certainties. Tobacco is bad for you. Too many calories result in obesity and that is also bad. But, guidelines are just that – they give advice but don’t give definitive answers. And science is ever changing and illuminating new understandings that are not immutable.

Do consumers have a role in health care – is there personal responsibility? Yes, of course, consumers have to be part of the equation. Indeed, consumers are the ones who suffer most directly from the effects of poor health choices. But we also can’t be so quick to judge the role consumers need to play when they are confused about what they should and shouldn’t do. We all want simple and easy answers to the health care cost dilemma. So, we often turn to things that sound good – like personal responsibility. But, when guidelines change after years of sounding so certain, it’s no wonder consumers are just confused.