Dr. Peter J. Weiss

Pres­i­dent Bill Clin­ton signs the Per­sonal Respon­si­bil­ity and Work Oppor­tu­nity Rec­on­cil­i­a­tion Act of 1996.

After the Repub­li­can and Tea Party surge last Novem­ber, many have called for Pres­i­dent Obama to emu­late Bill Clinton’s shift to the cen­ter in response to the 1994 Repub­li­can elec­tion vic­to­ries.

Truth be told, that shift did seem to work out well, both for Pres­i­dent Clin­ton and for the coun­try.  The history-making reform of America’s wel­fare sys­tem was one of the major achieve­ments result­ing from the sub­se­quent coop­er­a­tion of Pres­i­dent Clin­ton and con­gres­sional lead­ers.

Offi­cially known as the Per­sonal Respon­si­bil­ity and Work Oppor­tu­nity Rec­on­cil­i­a­tion Act of 1996, wel­fare reform was hotly debated at the time.  Many argued that it was sim­ply cold-hearted and wrong to limit wel­fare ben­e­fits and push aid recip­i­ents to get jobs.

Here’s what Con­gress­man Jim McDer­mott had to say at the time, “This bill is the most cruel and short­sighted view in pub­lic pol­icy I have seen in 25 years.”

That’s pretty harsh crit­i­cism.

With­out get­ting into the details, the bill was intended to help end a “cul­ture of depen­dency” and move peo­ple from wel­fare to work.  It was rev­o­lu­tion­ary to require wel­fare ben­e­fi­cia­ries to get work within two years and to place firm lim­its on the total assis­tance to indi­vid­u­als and fam­i­lies.

But the bill passed and Pres­i­dent Clin­ton com­mented that,”…this leg­is­la­tion pro­vides a his­toric oppor­tu­nity to end wel­fare as we know it and trans­form our bro­ken wel­fare sys­tem by pro­mot­ing the fun­da­men­tal val­ues of work, respon­si­bil­ity, and fam­ily.”

He was right.  Wel­fare case­loads dropped and peo­ple found jobs.  Did the bill solve all of our nation’s poverty and wel­fare issues?  Of course not, but it was a step in the right direc­tion and, look­ing back, most ana­lysts now judge the act a suc­cess.

Can we do some­thing sim­i­lar with health­care?

Our cur­rent health­care sys­tem can also be viewed as a cul­ture of depen­dency.  We live in ways that harm us and then ask physi­cians and other providers to “fix” our self-induced ill­nesses.

As with wel­fare recip­i­ents of the early 90’s, we get stuck in the health­care sys­tem — receiv­ing more “aid” each year with­out ever chang­ing our habits and get­ting well.

Imag­ine for a minute that health­care reform looked like wel­fare reform.  What if health­care ben­e­fits for lifestyle-induced ill­ness were lim­ited to five years?

What if seden­tary and over­weight patients were required to become active, eat dif­fer­ently and lose the weight in order to con­tinue to receive gov­ern­ment health­care ben­e­fits?

“Too rad­i­cal,” you say?  Per­haps, but that’s what they said back in 1996 too.

Now I’m not seri­ously sug­gest­ing this approach, but I am say­ing that we have per­verse incen­tives in the health­care sys­tem — incen­tives which are sim­i­lar to those of the pre-reform wel­fare sys­tem.

Our last go at health­care reform didn’t help much.  The law is all about pro­vid­ing more health­care when what we need is more health.

As Con­gress tack­les reform or repeal of the Patient Pro­tec­tion and Afford­able Care Act of 2010, our rep­re­sen­ta­tives should seri­ously con­sider the role of per­sonal respon­si­bil­ity in health­care. Let’s help indi­vid­u­als to be well, but let’s also let them bear the finan­cial cost of their refusal to change.

Any health­care pro­fes­sional will tell you that patients with lifestyle ill­nesses can and do get well — when they are truly com­mit­ted and have appro­pri­ate sup­port.

As a soci­ety, we’re ask­ing too lit­tle of our­selves and mak­ing it too easy to be sick.  Let’s have more health and less care.

I imag­ine Pres­i­dent Obama sign­ing a “More Health Less Care Act of 2011″ while say­ing, “This leg­is­la­tion pro­vides a his­toric oppor­tu­nity to end health­care as we know it and trans­form our bro­ken health­care sys­tem by pro­mot­ing the fun­da­men­tal val­ues of per­sonal respon­si­bil­ity, healthy lifestyles and self-control.”

We can do it!