Forest Fires, Earthquakes, the Titanic, and Healthcare

Henry David Thoreau wrote that "[a]ll perception of truth is the detection of an analogy."  Let's use analogies to comprehend the seemingly incomprehensible: healthcare in the U.S.  Below, the word "they" refers to power brokers in Washington, on both sides of the aisle and in the White House.

  • They are concentrating on one vein on one leaf of one tree, while the whole forest is ablaze.
  • They remain intensely focused on a tiny germ under a microscope while an earthquake is destroying the lab.
  • They have precisely lined up all the deck chairs on their magnificent new "unsinkable" ship -- the Titanic.
  • They are applying anti-acne cream to a patient with a brain tumor.

The truth in these analogies seems obvious to you and me, but apparently it escapes people who work within the Beltway.

The "doctors" for the critically ill U.S. healthcare system -- our representatives in Washington -- are altering financing and expanding regulations, apparently without any understanding of why the patient, healthcare, is sick.  As a result of their treatment, the patient is deteriorating.  Indeed, patient healthcare is dying.  When it goes, we will go with it.  

The following is a list of healthcare's signs and symptoms.  Every good nurse or doctor knows that you don't treat these.

Ø  Spending too much, both individually and as nations.

Ø  Lack of health care goods and services.

Ø  Shortages of trained personnel.

Ø  Limitations in access.

Ø  Errors and adverse impacts.

Ø  Variations in both quality and payment for similar services.

Ø  Medical bills were formerly the leading cause of personal bankruptcy in the U.S. until the 2009 real estate collapse.  Medical bills have now "slipped" to second place.

The list above does not include the causes of the patient's woes.  Those are the things you do treat, like perverse incentives, action without evidence, worthless spending that delivers no value, suppression of market forces, and prevention of learning.

You cannot cure over-spending by spending even more, as does the PPAHCA (Patient Protection and Affordable Health Care Act, called "ObamaCare").  You determine where the dollars are truly going -- the "spending" -- and decide which of those expenditures is "over-," meaning which dollars spent have a negative cost-benefit ratio.

The Beltway doctors say they are "fixing" healthcare by infusing competition through health exchanges.  Those exchanges actually expand government control of healthcare and thereby suppress free-market forces that give consumers better, cheaper, and quicker service.  Even as Congress promises lower insurance costs through federally mandated exchanges, you and I see our insurance premiums skyrocket.

Congress reduces payments to providers, and at the same time, they pay more to themselves.  We get fewer doctors and nurses but more bureaucrats.  Trillions are paid to healthcare -- the system -- leaving less and less for health care -- the service.  As Robert Moffit of the Heritage Foundation testified before Congress, "[o]ne cannot get more of something by paying less for it."

The only people we can count on to act in our best interests are we -- not as in the U.S., but as in you and me, We the Patients, speaking as We the People.  What should we do?

Sick patients, like healthcare itself, should be treated by people who know how to practice good medicine.  The self-proclaimed healers of healthcare in Washington repeatedly shout: "Trust me!  I have your best interests at heart!  Pay no attention to who is funding my re-election campaign."  You can easily see how healthcare is doing under their fine care.

The following are the four basic principles of good medical practice, whether the patient is a sick person or a sick system.  This is what the Washington doctors are not doing.

  1. Evidence-based decision-making.
  2. Treat causes, not symptoms.
  3. Long-term (cost + risk) benefits analysis required.
  4. Partnership with the patient.

What should We the Patients do?  First, we must accept the job of becoming We the Doctors for healthcare.  If we wait for someone else, it won't get done, let alone get done right.

Next, we must accept the fact that the "system" we currently have cannot be adjusted, managed, tweaked, or reformed to make it efficient and effective.  It is not simply a broken system.  It is no system at all.  We need to create a real system, one that works...for us.

Congress is guilty of nano-managing healthcare, which is "a thousand times worse than micromanagement."  They substitute logic and passion for hard data and cost-benefit analysis.  We must demand that all congressional actions have evidence in advance of legislation.  Such evidence must include, as the engineers say, both problem definition and proof of effect.

Finally, though we are temporarily acting as doctors for healthcare, we also remain We the Patients.  It is crucial that we demand a partnership with the federal government.  We want the exact opposite of how we were treated with regard to PPAHCA.

Henry David Thoreau wrote that "[a]ll perception of truth is the detection of an analogy."  Let's use analogies to comprehend the seemingly incomprehensible: healthcare in the U.S.  Below, the word "they" refers to power brokers in Washington, on both sides of the aisle and in the White House.

  • They are concentrating on one vein on one leaf of one tree, while the whole forest is ablaze.
  • They remain intensely focused on a tiny germ under a microscope while an earthquake is destroying the lab.
  • They have precisely lined up all the deck chairs on their magnificent new "unsinkable" ship -- the Titanic.
  • They are applying anti-acne cream to a patient with a brain tumor.

The truth in these analogies seems obvious to you and me, but apparently it escapes people who work within the Beltway.

The "doctors" for the critically ill U.S. healthcare system -- our representatives in Washington -- are altering financing and expanding regulations, apparently without any understanding of why the patient, healthcare, is sick.  As a result of their treatment, the patient is deteriorating.  Indeed, patient healthcare is dying.  When it goes, we will go with it.  

The following is a list of healthcare's signs and symptoms.  Every good nurse or doctor knows that you don't treat these.

Ø  Spending too much, both individually and as nations.

Ø  Lack of health care goods and services.

Ø  Shortages of trained personnel.

Ø  Limitations in access.

Ø  Errors and adverse impacts.

Ø  Variations in both quality and payment for similar services.

Ø  Medical bills were formerly the leading cause of personal bankruptcy in the U.S. until the 2009 real estate collapse.  Medical bills have now "slipped" to second place.

The list above does not include the causes of the patient's woes.  Those are the things you do treat, like perverse incentives, action without evidence, worthless spending that delivers no value, suppression of market forces, and prevention of learning.

You cannot cure over-spending by spending even more, as does the PPAHCA (Patient Protection and Affordable Health Care Act, called "ObamaCare").  You determine where the dollars are truly going -- the "spending" -- and decide which of those expenditures is "over-," meaning which dollars spent have a negative cost-benefit ratio.

The Beltway doctors say they are "fixing" healthcare by infusing competition through health exchanges.  Those exchanges actually expand government control of healthcare and thereby suppress free-market forces that give consumers better, cheaper, and quicker service.  Even as Congress promises lower insurance costs through federally mandated exchanges, you and I see our insurance premiums skyrocket.

Congress reduces payments to providers, and at the same time, they pay more to themselves.  We get fewer doctors and nurses but more bureaucrats.  Trillions are paid to healthcare -- the system -- leaving less and less for health care -- the service.  As Robert Moffit of the Heritage Foundation testified before Congress, "[o]ne cannot get more of something by paying less for it."

The only people we can count on to act in our best interests are we -- not as in the U.S., but as in you and me, We the Patients, speaking as We the People.  What should we do?

Sick patients, like healthcare itself, should be treated by people who know how to practice good medicine.  The self-proclaimed healers of healthcare in Washington repeatedly shout: "Trust me!  I have your best interests at heart!  Pay no attention to who is funding my re-election campaign."  You can easily see how healthcare is doing under their fine care.

The following are the four basic principles of good medical practice, whether the patient is a sick person or a sick system.  This is what the Washington doctors are not doing.

  1. Evidence-based decision-making.
  2. Treat causes, not symptoms.
  3. Long-term (cost + risk) benefits analysis required.
  4. Partnership with the patient.

What should We the Patients do?  First, we must accept the job of becoming We the Doctors for healthcare.  If we wait for someone else, it won't get done, let alone get done right.

Next, we must accept the fact that the "system" we currently have cannot be adjusted, managed, tweaked, or reformed to make it efficient and effective.  It is not simply a broken system.  It is no system at all.  We need to create a real system, one that works...for us.

Congress is guilty of nano-managing healthcare, which is "a thousand times worse than micromanagement."  They substitute logic and passion for hard data and cost-benefit analysis.  We must demand that all congressional actions have evidence in advance of legislation.  Such evidence must include, as the engineers say, both problem definition and proof of effect.

Finally, though we are temporarily acting as doctors for healthcare, we also remain We the Patients.  It is crucial that we demand a partnership with the federal government.  We want the exact opposite of how we were treated with regard to PPAHCA.