by Thomas Dahlborg

Now that health reform has passed I was reflecting again on the question:

"Is healthcare a right or a privilege?"

In line with President Kennedy's famous inaugural address from 1961 there is a third option: "Healthcare is an obligation."

We as individuals are obligated to take care of our own health. To eat right, to exercise right, to get enough sleep, to find healthy options to relieve stress, to stop smoking, to drink alcohol in moderation, to develop healthy relationships, to maintain an optimal weight, to ensure optimal conditioning prior to engaging in sports, to wear a bike helmet when riding a bike, to wear a safety belt when in a car, to follow scientific-based prevention guidelines best suited to you as an individual, to make one's health a priority, to develop and manage a healthcare-related budget and so much more.

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Living up to these obligations alone will significantly improve the health of individuals and communities and lower the cost of healthcare more than any top-down approach. All of us honoring these commitments would literally change the world.

Beyond these personal obligations, we must also continue to identify barriers to good health, to identify the root-cause of these barriers, to stand up in community to break these barriers down, and to support one another in doing so.

Some of these roadblocks include:

* Reimbursement barriers such as primary care physicians having to generate 25 to 30 or more relative value units per day and physician practices having to make up financial shortfalls by ordering ever more ancillary services and driving up the cost of care (especially as reimbursement rates are reduced).

* Access-related barriers such as cultural, language, education, limited number of high-quality physicians in rural areas and more.

* Environmental barriers such as pollution, harmful food chemicals and food production techniques and more.

* Political barriers such as the politics of stakeholders in the healthcare system (insurers, politicians, providers) who aren't focused on the greater good of the community.

* Financial barriers such as balancing the inability for some to afford high-quality, value-based health care with the human need to give, to earn, to be needed, and to be honored.

We have voices, we have our energy and we have our obligation to stand up, to get involved and to make a significant difference.

The passage of health reform doesn't make our obligations go away.

What can we, as providers and as individuals, do for our country to significantly improve the health of individuals and communities? Much! Let's begin by living up to our obligation to take care of ourselves, our families, and our communities.

Thomas H. Dahlborg, M.S.M., is executive director of the physician practice True North Health Center, where he focuses on improving growth while ensuring access for the uninsured and the elderly. He has 21 years of experience creating competitive advantages, analyzing customer expectations, and developing and implementing focused and aligned strategic deployment plans. Formerly he served as the chief business strategy officer at Network Health, a comprehensive Medicaid health plan based in Cambridge, Mass.; and was COO of the U.S. Family Health Plan at Martin's Point Health Care in Portland, Maine.