Thursday, January 14, 2016

One Asshole's (Informed) Opinion: Everything you read about health care is wrong

There is no such thing as a "health care system" in North America.
No, that statement is not a setup for something cutesy like, "every state/province has its own health care system!". As I'm going to argue on this blog, systems-level thinking about health care, which is a political-social philosophy very much in vogue these days, isn't going to be any more useful than the thinking that's already out there. In fact, no analysis of the so-called health care system is going to be of use, at least not until you consider each component part of the system separately. And they must be considered separately...each "silo" (No! Not silos! We hate silos!!) in health care is the way it is with good reason. The insurance plans, medication funding, hospitals, and so on, are wildly disparate institutions, and each plays by entirely different economic rules than the others.



Let me back up. We typically find four types of hogwash "analysis" when it comes to health care in the mass media. The first I'll call the socialist opinion, that goes something like this:

Health care is a fundamental right. The most efficient way to pay for it is through universally mandated, publicly funded health insurance, or outright state ownership (with health professionals as salaried government employees). Allowing people to buy better care is unfair to the most disabled people in society. If professionals are allowed to work to the limits of their qualifications, with the proper mandates, carrots, and sticks in place, we can save money, increase healthcare worker satisfaction, and improve care. People in health care are all on the same side, and are only in it for the best interests of the patient; never in 1000 years would they care about anything else. 

Next up is the conservative opinion, along these lines:

The problem with the health care system is that it's a state-controlled monopoly, and not treated as a service industry. Because the government dictates how much providers are paid and limits their autonomy, they have no incentive to innovate and use sound business ideas to improve service. The government health department/ministry is a wasteful, bloated bureaucracy that serves only to feed itself. If we don't put a stop to this, in a few years, just you wait...they're going to build Soviet-style work camps for doctors and nurses, ration care for the elderly so we all die penniless in overcrowded nursing homes.

Next we have the cost-obsessed "grey tsunami" line of thinking:

At its current rate of growth, taking into account the aging of the baby boomer generation, health care spending is unsustainable. The public's insatiable appetite for health care will crowd out every other area of government spending. It must be brought in line with tax revenues, that are only going down in the current economic climate. Consider this: in 1960, health care was only 3% of GDP; by 2000, that number was 15%. At that rate, by 2064 health care will consume 129% of GDP. What happens then is that we have to print money and get Zimbabwe-level inflation.

Finally there's TED-talk optimism:

The problem with health care isn't a lack of money, or excess bureaucracy, or even sick people. It's that we're stuck in our old, calcified patterns of thought. We need to demolish silos, tear down hierarchies, open our minds, metaphor, metaphor, metaphor. Once we've destroyed these archaic ways of thinking like ISIS is doing to Middle East historical sites, we can build from the ground up using innovation, integrated horizontal teamwork, continuous quality improvement, buzzword, buzzword, buzzword. We just need to unlock our untapped potential and mixed-metaphor, buzzword, bullshit.

If you can look beyond my snark, you'll notice that none of these lines of thought seems to intersect at all with the others. The first argues for what it feels is the best funding scheme, and adds some ideas on how to tweak service delivery. The second is almost all ideology, although the contempt for too much bureaucracy is not unjustified. The third, while laying claim to taking a "big picture" view of government priorities and finances, is so broad and devoid of context that it should be dismissed out of hand. And the last one? Well, in the immortal words of Lord Business: 


I can guess what you're thinking. What are the fundamental problems, if not what we hear and read about everywhere?

In this Asshole's opinion, before we start laying blame or offering solutions, we might just want to start by figuring out how health care is actually structured, and, I don't know...works?

Next time.

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