The excesses of individualism. For meaningful healthcare reform, the United States needs a renewed sense of community.

In the United States at the end of the twentieth century, the balance of values tilts too far toward the individual and away from the community. What is needed is a renewed sense of community that enhances the lives of individuals as it serves the common good. The first step toward creating a new balance is a critique of the present imbalance, which is shaped by excessive forms of individualism that affect every aspect of our healthcare delivery system. Technological individualism occurs when the value of technology is measured only by its service to the individual. The results are a technological imperative, unreasonable expectations on the part of the community, distorted judgement on the statistical likelihoods of individual outcomes, fragmentation of care, and a reliance on rescue medicine. A psychosocial individualism has misshapen our attitudes about ourselves and our communities, bringing with it a deepening sense of alienation. The results in U.S. healthcare include commercialization, exclusion of the poor, a litigious provider-patient relationship, declining respect for life, and a sense of community that excludes other generations and nations. Libertarian individualism has created political isolation and prevents the evolution of democratic decision making and real partnerships in healthcare. The results are an unpooling of insurance risk, an interpretation of freedom that is inimical to family and community ties, hostility to government, a view of healthcare as a commodity, and deprofessionalization of the medical professions. Healthcare reform must seek to change what medical technology does for us, repair the psychosocial harms healthcare individualism has produced, and promote citizen participation in the healthcare system in new and important ways.