Cyreenik Says
Health care. It's like the weather, almost, everyone talks about it, no one seems happy with the way it is. No one can come up with a plan that makes it all better.
Here is my summary of the root of the problem:
The root of the health care problem is that it is not a two-sided relation between a customer and a service provider. It is a many-sided relation, and patients are not the customers of health care providers, insurance companies are.
Now some details of this problem.
The root of the health care problem, and many other hard-to-solve problems, is that they suffer from The Curse of Being Important. Being afflicted by The Curse means that way too many people are interested in the process and the extra people support extra meddling. The result of this extra meddling is that projects suffering from The Curse have some distinctive development patterns:
o They have less flexibility than they should.
o They cost more than they should.
o They have too much paperwork and external oversight for their size.
o Because they have too much paperwork and low flexibility, only big versions of this kind of project are considered feasible. The community never sees or gets to decide on the value of small versions.
o Because there aren't dozens-to-thousands of small versions being explored and experimented with, the full capabilities, the most efficient procedures, and the surprise benefits of the process are never discovered.
o The results don't please people much, so there's lots of bitching about the poor results, but little success in doing better.
o There are many, many missed opportunities to do better that the public remains mostly oblivious to.
These are consistent characteristics of projects that suffer from The Curse of Being Important.
Now back to health care specifically.
A customer is the entity which pays for work done by the service provider.
In the US system, the biggest customer is insurance companies, and the second biggest customer is the government. Patients aren't customers ... unless they are <gasp> uninsured.
So, if patients aren't customers, what are they?
Patients are "tickets". Patients are "punched" by health care providers, who then hand those punches to the insurance companies for money.
This is the root of all the distortion in the health care industry. If patients were paying, they would be customers, and the industry would pay a lot of attention to them, and it would run very differently. To many people and organizations, it's scary how different it would be.
Paying serious attention to who pays you is the natural order of things, no matter what social system is in effect.
What the government, and everyone else involved, should be looking for is a way to put paying back into the hands of patients -- plans to do anything else are just band-aid plans that won't solve the bitching or the inefficiencies -- inefficiences as seen by patients, that is.
There is a second issue here that's related and just as important: enfranchisement. Enfranchisement is the feeling that what a person is doing and saying is important to the community. It's the feeling that a person is making a difference, and that the community is paying attention to that person. Any system which doesn't build enfranchisement into the system is doomed to chronic bitching and lost faith on the part of the participants. The theme of a seriously disenfranchised participant is, "I don't care anymore." Having lots of people feeling "I don't care anymore"ish is something any good health plan needs to avoid.
One solution that doesn't seem to be getting its fair share of attention is breaking this big complex problem into smaller, less complex parts. If the problem is broken into parts, those can be solved, one-by-one, and a lot of the emotional heat and fear, uncertainty, and doubt about how to solve this issue can be cleared up.
Here is what I propose:
o Let's take this big problem and break it into smaller, solvable, parts.
o Let's remember that enfranchisement is the key to a lasting, low-bitch solution. This means that patients must be given serious responsibility, and that patients must take that responsibility seriously, which means we as a community must teach health care responsibility just as we teach all other good lifestyle techniques.
o Let's remember that part of the key to enfranchising is having the patient pay for the service, so that it is easy and natural for health care workers throughout the health care organizations to pay serious attention to patients, and it's easy and natural for patients to shop well as they make their health care choices.
Can health care ever be released from The Curse of Being Important? That I strongly doubt. But, if we recognize it's suffering from the curse, we can do more to recognize who should have the important say and who should back off. And to my way of thinking, it's the patients and the health care providers who should have the most important say.
-- The End --