Fidelity and Stewardship as the Guiding Values for Medicare

I've used this diagram for many years in teaching about the ethics of health care provided to a population within a budget - HMOs, ACOs, VA, public sector mental health, and countries that provide universal coverage. Given the absurdly fragmented system we have in the U.S., it's difficult for patients, physicians and the public to have a sense of the denominator we're part of (the population served under a budget).

I believe the diagram shows the right ethical perspective on Medicare. We want attention to the needs of the individual to predominate in the exam room, but not to the total exclusion of awareness of our responsibilities to others as well as to ourselves. We want attention to the needs of the population to predominate at the policy level, but not to the total exclusion of awareness of the implications of policy decisions on individuals.

Ability to embrace complexity is part of maturity. I'm convinced that if we were able to survey the Medicare population, a large majority would embrace the moral perspective shown in the diagram. Wider endorsement of fidelity to the needs of the individual AND stewardship of shared resources on behalf of the population will provide the ethical basis for doing what we need to do to make Medicare secure for the future.

My aim for this new blog is to encourage my fellow members of the Medicare community to give stronger voice to fidelity AND stewardship as the proper guiding values for Medicare reform.