Arguing About the Wrong Things

Arguing about the Wrong Things

The current debate grabbing our nation’s attention is not about healthcare. The “healthcare” bills in Congress, the President’s townhall, “healthcare” meetings, etc. have very little to do with health and almost nothing to do with care. They are an effort to change how we pay for our current mess, but what we pay for something is very different than the something itself. Words matter. So let’s be careful we don’t mistake “health insurance” for “health care” and make a very expensive decision that further endangers our health.

So what is the It that is healthcare in the U.S? What do we want It to be? We should answer those questions before enduring a divisive fight about whether the government, employers or individual families should finance It. It is a bad idea to buy something, especially a very expensive something, unless you have some idea of what you’re getting. This truth makes the debate about who should pay for healthcare a distracting sideshow. Whether the money is funneled through private or government insurance programs or comes directly out of corporate or family bank accounts matters much less than whether we buy a system that works. Ultimately, individual citizens will pay for the healthcare we receive. We’ll either pay directly or indirectly through insurance premiums, taxes, or lower incomes. There’s no free lunch here so it might be worthwhile to think about what we’re ordering before debating how to split the bill.

So here’s the good and bad news.

The good news is we don’t need to fix a “broken healthcare system”. The simple reason is we don’t have a “system” at all! A system implies design. The assumption in a system is that someone or a collection of someones thought through what the system should do and how it should be put together. Henry Ford designed and built a system to make cars efficiently. That is not the history of healthcare in the U.S.

What we have is a collection of habits, profit centers and non-profit organizations presented in a bewildering maze of chaos. As patients you experience the inefficiency of this all the time. You feel it when you fill out forms repeatedly. You suffer from it when your doctors have no way of efficiently communicating with each other and no strong inclination to even try. The examples are endless. It troubles me that physicians will rarely address this truth. We generally prefer to hide behind silly and harmful clichés like “We have the best healthcare system in the world.” There’s little evidence to support such a claim, but the American Medical Association loves it and has done a good job of teaching it to too many influential politicians. Doctors generally like it because it pats us on the back for the care we do provide and helps maintain the status quo that supports our lifestyles.

The bad news is that since we don’t yet have a healthcare “system” in the U.S., we need to build one if we want better outcomes. Maybe this really isn’t bad news. It might be healthy for the U.S. to wrestle with how much emphasis we want to place on prevention, disease treatment, specialist care, primary care, technology etc. It would be very rewarding work to design a system to deliver the agreed upon balance. A national discussion on what to buy in healthcare won’t be easy, but it needs to happen before the actual purchase.