A Patient, a Doctor, and Three Burly Nurses

March 23, 2012 marked the two-year anniversary of President Obama's signing into law of the Patient Protection and Affordable Health Care Act (PPAHCA, now shortened to ACA), pejoratively called ObamaCare.  On that day on local radio, I debated State Senator Dede Feldman (D-Albuquerque) about the ACA.  During the discussion, an analogy came to me that can clarify the issues surrounding Congress' self-styled, ill-conceived "reform" of U.S. healthcare via the ACA.

A patient, whose name is M. Healthcare, enters a doctor's office with two chief complaints: 1) overspending -- both individually and nationally -- and 2) "cannot get health care."

After hearing the patient's complaints and without further ado, the doctor calls in three burly male nurses.  They hold the patient down, and the doctor forces a foul-tasting snake-oil preparation into the patient's mouth.  During this procedure, the doctor loudly proclaims that this will cure the patient.  "Trust me," says the physician.

With the patient still restrained, the doctor takes the patient's wallet, removes all the money, and garnishes the patient's wages for the next twenty years.  With beatific smiles, the nurses then release the patient, saying that what they did was for the best.

Clearly these providers engaged in gross malpractice, just as Congress did with the ACA.

Our Congressional doctors made no attempt to determine the causes of patient Healthcare's symptoms: overspending and no care.  Where did all that money go?  Do we really want it to go there?  What are the reasons why the patient cannot get timely, high-quality care when needed?

Doctors for humans are required to be evidence-based in their recommendations to the patients.  They review past experience to see what worked, what did not, and why.  Why didn't Congress behave the same way before passing the ACA?

Had they done so, our representatives would see people dying while waiting in line for approved care in Canada.  They could observe British denial of care based on age.  Closer to home, there is Massachusetts with Commonwealth Care, also called RomneyCare or ObamaCare Lite.  In the Bay State, a woman with pelvic pain must wait six weeks before she can see an ObGyn.  Over half of all doctors in Massachusetts do not accept Commonwealth Care patients because they cannot afford to; reimbursements are so low that the doctors go out of business.

A doctor is a fiduciary.  The good doctor advises.  The good doctor never forces his or her will on the patient.  The providers committing malpractice in the analogy above are also guilty of battery as well as of stealing.  With the ACA, Congress is guilty of all three: malpractice, battery, and theft, plus indenturing our grandchildren.  They do this because Washington is populated with magical thinkers who believe, Because I want it and because I mean well, everything will turn out just fine.

The alternative to a diagnosis of magical thinking by our representatives is too hideous to contemplate.  If they actually knew that the ACA would be healthcare exacerbation (opposite of reform), they wouldn't have passed it.  So it must be -- it had better be -- magical thinking.

Future indentured servitude is clear.  Though the patient (Healthcare) came in complaining of overspending, the Congressional doctors with their ACA will spend an additional $1.76 trillion (latest GAO estimate).  These are dollars we do not have, and thus, they will be added to the deficit.  This is a debt that must be paid back by our grandchildren.

During our debate, Senator Feldman regaled the audience with all of the new rules and regulations to protect the patients, to insure adequate coverage, to constrain rising costs, and to eliminate "inequality in healthcare" (her words).

Take a step back.  Think about the system and about yourself.  What ACA does, what Congress has repeatedly done, is add more and more complexity to an already incomprehensible, extremely inefficient, and user-unfriendly system.  I am being kind with the word "user-unfriendly."  Healthcare and particularly its insurance component are actively user-hostile.

Always keep in mind the way healthcare financing is structured: make profit (private insurance) or stay within budget (government) by not spending money.  For these entities, "success" is defined by not providing care.

The ACA diverts funds from care to management.  The money collected by the government, in taxes, by the individual mandate (if upheld), and by penalties, will be given to bureaucrats and taken away from providers.  Medicare reimbursements have been cut by the ACA by over 20%.  So, they take resources from care services for patients and give them to bureaucrats because of healthcare's massive administrative complexity.

Most people believe that complexity cannot be avoided, that it is inevitable.  It isn't.  Many people believe that they don't have to pay for administrative complexity.  They (we) do, hugely.  No one thinks that complexity hurts us.  It does, in numerous ways.

Any operations expert will tell you that the more complex a system is, the more inefficient (wasteful) it is.  No wonder the healthcare system consumes a trillion dollars a year that could (and should) be spent on health care but is not.  That is real money -- our money -- that the government gives to itself, rather than spending it on We The Patients.

Complexity in healthcare is a measure of the failure of the designers, lawmakers, and policy experts to do what they should do: simplify healthcare.

  • As complexity escalates, the system is more prone to errors.
  • As complexity increases, opportunities for fraud and embezzlement multiply.
  • As complexity increases, the system becomes less sensitive to the individual.
  • As complexity increases, costs explode (just like they are doing). And the solution that the government uses to combat this is...increased complexity (even more rules and regulations)!

Do you see a pattern here?  I certainly do.

Amidst all the political maneuvering, the convoluted legal arguments, and a nation focused on gamesmanship, let's keep poor, sick Healthcare in mind.  The patient's overspending has gotten much, much worse.  As for difficulty findings medical care, there are no doctors or nurses, and hospitals are going out of business.

So much for Washington's "reform" of healthcare.

March 23, 2012 marked the two-year anniversary of President Obama's signing into law of the Patient Protection and Affordable Health Care Act (PPAHCA, now shortened to ACA), pejoratively called ObamaCare.  On that day on local radio, I debated State Senator Dede Feldman (D-Albuquerque) about the ACA.  During the discussion, an analogy came to me that can clarify the issues surrounding Congress' self-styled, ill-conceived "reform" of U.S. healthcare via the ACA.

A patient, whose name is M. Healthcare, enters a doctor's office with two chief complaints: 1) overspending -- both individually and nationally -- and 2) "cannot get health care."

After hearing the patient's complaints and without further ado, the doctor calls in three burly male nurses.  They hold the patient down, and the doctor forces a foul-tasting snake-oil preparation into the patient's mouth.  During this procedure, the doctor loudly proclaims that this will cure the patient.  "Trust me," says the physician.

With the patient still restrained, the doctor takes the patient's wallet, removes all the money, and garnishes the patient's wages for the next twenty years.  With beatific smiles, the nurses then release the patient, saying that what they did was for the best.

Clearly these providers engaged in gross malpractice, just as Congress did with the ACA.

Our Congressional doctors made no attempt to determine the causes of patient Healthcare's symptoms: overspending and no care.  Where did all that money go?  Do we really want it to go there?  What are the reasons why the patient cannot get timely, high-quality care when needed?

Doctors for humans are required to be evidence-based in their recommendations to the patients.  They review past experience to see what worked, what did not, and why.  Why didn't Congress behave the same way before passing the ACA?

Had they done so, our representatives would see people dying while waiting in line for approved care in Canada.  They could observe British denial of care based on age.  Closer to home, there is Massachusetts with Commonwealth Care, also called RomneyCare or ObamaCare Lite.  In the Bay State, a woman with pelvic pain must wait six weeks before she can see an ObGyn.  Over half of all doctors in Massachusetts do not accept Commonwealth Care patients because they cannot afford to; reimbursements are so low that the doctors go out of business.

A doctor is a fiduciary.  The good doctor advises.  The good doctor never forces his or her will on the patient.  The providers committing malpractice in the analogy above are also guilty of battery as well as of stealing.  With the ACA, Congress is guilty of all three: malpractice, battery, and theft, plus indenturing our grandchildren.  They do this because Washington is populated with magical thinkers who believe, Because I want it and because I mean well, everything will turn out just fine.

The alternative to a diagnosis of magical thinking by our representatives is too hideous to contemplate.  If they actually knew that the ACA would be healthcare exacerbation (opposite of reform), they wouldn't have passed it.  So it must be -- it had better be -- magical thinking.

Future indentured servitude is clear.  Though the patient (Healthcare) came in complaining of overspending, the Congressional doctors with their ACA will spend an additional $1.76 trillion (latest GAO estimate).  These are dollars we do not have, and thus, they will be added to the deficit.  This is a debt that must be paid back by our grandchildren.

During our debate, Senator Feldman regaled the audience with all of the new rules and regulations to protect the patients, to insure adequate coverage, to constrain rising costs, and to eliminate "inequality in healthcare" (her words).

Take a step back.  Think about the system and about yourself.  What ACA does, what Congress has repeatedly done, is add more and more complexity to an already incomprehensible, extremely inefficient, and user-unfriendly system.  I am being kind with the word "user-unfriendly."  Healthcare and particularly its insurance component are actively user-hostile.

Always keep in mind the way healthcare financing is structured: make profit (private insurance) or stay within budget (government) by not spending money.  For these entities, "success" is defined by not providing care.

The ACA diverts funds from care to management.  The money collected by the government, in taxes, by the individual mandate (if upheld), and by penalties, will be given to bureaucrats and taken away from providers.  Medicare reimbursements have been cut by the ACA by over 20%.  So, they take resources from care services for patients and give them to bureaucrats because of healthcare's massive administrative complexity.

Most people believe that complexity cannot be avoided, that it is inevitable.  It isn't.  Many people believe that they don't have to pay for administrative complexity.  They (we) do, hugely.  No one thinks that complexity hurts us.  It does, in numerous ways.

Any operations expert will tell you that the more complex a system is, the more inefficient (wasteful) it is.  No wonder the healthcare system consumes a trillion dollars a year that could (and should) be spent on health care but is not.  That is real money -- our money -- that the government gives to itself, rather than spending it on We The Patients.

Complexity in healthcare is a measure of the failure of the designers, lawmakers, and policy experts to do what they should do: simplify healthcare.

  • As complexity escalates, the system is more prone to errors.
  • As complexity increases, opportunities for fraud and embezzlement multiply.
  • As complexity increases, the system becomes less sensitive to the individual.
  • As complexity increases, costs explode (just like they are doing). And the solution that the government uses to combat this is...increased complexity (even more rules and regulations)!

Do you see a pattern here?  I certainly do.

Amidst all the political maneuvering, the convoluted legal arguments, and a nation focused on gamesmanship, let's keep poor, sick Healthcare in mind.  The patient's overspending has gotten much, much worse.  As for difficulty findings medical care, there are no doctors or nurses, and hospitals are going out of business.

So much for Washington's "reform" of healthcare.

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