Note: I originally published this post in February 2017. A lot has changed in the healthcare marketplace since then. And a lot has not. I decided to update this post to see whether I could find a healthcare system two years later.
I’m always struck by the amount of time, energy and literature devoted to creating alternative worlds, with alternative goals, objectives and creatures. Next time you wander through your local bookstore, pay close attention to how large the
Fantasy sections are, and you’ll start to get a feel for the level of effort. Did you know the first unicorn was described in Greek literature as being a native of India some 3,000 years ago?
Similar levels of effort seem to be generated all the time to try and resolve problems with healthcare in the United States. Real, honest, doable solutions, much like vampires, never seem to come out in the daylight. I’ve come to believe there are some simple reasons for this phenomenon.
The “Healthcare System” is a Mythical Creature
Healthcare cannot be treated as a system. Why not? I mean, we always talk about the “healthcare system” as if it is a real thing. Unless healthcare assumes this form by the light of the full moon like a werewolf, and I just missed it, there is no such thing. Disagree?
Review Merriam-Webster’s definition of the word “system”:
“a regularly interacting or interdependent group of items forming a unified whole”
Anyone who has worked in any area of U.S. healthcare for more than a few days knows that what we call “healthcare” does not approach this definition even vaguely. In no way is healthcare in the U.S. a “unified whole.” Yet the words persist, much harder to kill than any zombie, and we read them all the time: “healthcare system.” If I could cut the head off this trend, I would have done it already.
Now Mike, is that any way to talk? Anyway, what difference does it make WHAT we call it?
It makes a critical difference. Because we are all victims of this groupthink where we call healthcare a “system,” we consistently think system-type solutions will solve the problem. Do you feel like your healthcare is a good value today?
Or your insurance is a good deal? Can you afford it? Are you paying a fair price? Do you have any idea how much any part of your care costs before you get it? I’m betting no.
Such assumptions are evident when a party in power decided to make “sweeping changes to the healthcare system.” The larger and more comprehensive such bills become, the more likely they are to fail. Healthcare financing is a bit of a zero-sum game. At best, you can influence who are winners, and who are losers. And there are always winners and losers. Efforts to “repeal and replace” the Affordable Care Act (ACA) in 2017 met with the same problems. Imposing single-payer healthcare on the U.S. will cause the same problems. Both are system solutions to a non-system.
So why don’t we all just admit that we made up unicorns…eh….the words “healthcare system,” so we can move on to real fixes that will help real people? For maximum success with minimal negative impacts on real people, we should focus on incremental fixes that will make a difference NOW, not in some far-off future time and place.
Here at Blue Cross, we have embraced this concept and are moving forward with programs like Quality Blue Primary Care. We are moving at light speed with predictive modeling to identify people who are at risk of going into the hospital or getting very sick and have our Care Management team reach out to help them resolve their crisis BEFORE it arrives. These types of solutions are making a difference, one member at a time.
Fixing the Beast
The ACA made a really big attempt to “re-system” the whole individual market. Was it too big in scope? Maybe. Was it wrong to jam it through with no bipartisan support? Probably. Never forget that the likelihood that your massive new federal program will succeed is determined by the strength of the losers in the negotiation. If you don’t work hard enough to include the opposition in what you are trying to do, endless warfare and confusion will result. Texas v U.S., anyone?
So, should the Affordable Care Act be scrapped, or should it be fixed? I say “fixed.”
But Mike, all the problems with the ACA! Are you saying “let it ride”?
Not a chance. If you have followed me at all, you know the incremental changes the federal government and Congress could make to stabilize the individual market and stop the runaway train of rate increases. I’ve talked about changes that could make a difference a lot.
And finally, some good news.
As we move closer to the selection of our next round of presidential candidates for the 2020 election, I’ve noticed just a little bit of common sense breaking out. The “burn it all down and start over” crowds are starting to look more like unfed zombies as their leadership is abandoning them.
Most of the conversation is steering toward repairing the ACA, then doing away with the current private insurance system, which, after all, covers 170 million people with relatively high satisfaction marks.
These new conversations are a tacit admission that healthcare is not a system and thus not subject to system-level solutions at this time. They are good for those who purchase health insurance both on and off www.healthcare.gov, and have the potential to curb rate increases by addressing specific problems like high drug prices and poor outcomes.
It takes real humility to admit that you don’t have all the answers, something I’ve found far too rare among those who deal with healthcare in Washington D.C. For those who continue to believe they have all the answers, I have to ask whether they prefer unicorns, zombies, vampires or werewolves, because that is the level of reality they are dealing in. Or, to put it another way:
“If any man you meet tells you he understands our United States Healthcare as a system, he knows how it works and has all the answers, then you have either met a fool or a liar.” (Walter Williams, Economics Chair at George Mason University, live on-air 2005)
Dr. Williams clearly understood that healthcare is not a system, but people are hurting and suffering now, and we need to focus on fixing the things we can fix, minimizing disruption and getting all the players to start acting like partners, and not competitors. That’s how we’ll improve the health, and the lives, of all Louisianians (which is Blue Cross and Blue Shield of Louisiana’s mission, by the way).
How Will the Story End?
Today, two years after I initially tackled this subject, it’s still easy to find dragons and unicorns (I hear there are some of each on HBO and the Disney Channel). A healthcare system, not so much. But, the sensible, to-the-middle political conversations are a good start. They attack specific issues that are driving up the cost of people’s health insurance and driving carriers out of healthcare.gov in many states. They have the potential, if turned into legislation, to begin to stabilize the market and draw more competition into it.
That is, assuming they are acted upon. We must be vigilant and not be distracted by unreality, and we must stay focused on what matters: Real healthcare for real people. The storybook hero here would be partnerships on both sides of the aisle, which will save the day. Vampires and werewolves working together for a better Underworld, if you’ll pardon the analogy.
Hope that’s Straight enough for you.
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