The Great Healthcare Debate

While the site has been down, the rhetoric about “fixing healthcare” in the US has dramatically heated up. “We need to take the waste out of healthcare!” “We’re paying too much for healthcare!””Everyone should get all the healthcare they need regardless of cost!”

Without getting into the political debate, let’s just touch on these points from a quality perspective.

There’s a balance between cost, speed and quality that’s quite a challenge in healthcare. For example, if I order $5000 worth of tests on day 1, and can tell you your diagnosis on day 2 and start treatment, what’s that worth to you and your health (even if it turns out that 5 tests out of the 30 ordered didn’t help with the diagnosis)? How about taking the cost-effective route: I’ll order one test per day, evaluate the results, and then order the next test. It may take me 21 days to figure it out, while you are waiting all the while, but hey! it did cost less! So, in which example was there more waste???

Paying too much for healthcare…does that mean we are paying more than the value we receive, or just more thanwe desire to (or can afford to) pay?Most of us a) don’t know how much our healthcare actually costs; b) can’t judge the quality of the medical care we receive; and c)won’thaggle over the cost ofan IV solution when thecare of a loved one is at stake.There’s an emotional element of this debate that is not susceptible to logical reasoning. We see this in all the stories of people who have gotten poor care or ran out of money or their insurance wouldn’t cover a certain procedure. If we try to “ration” care in the most logical way possible, we immediately run into the emotional (or moral, if you prefer) discussion about denying care to those who need it on a purely financial basis. The factual and emotional issues are entangled as we debate this topic.

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Should everyone get the healthcare they need regardless of cost? It’s my personal opinion that provision of basic services, including healthcare, should bea function of an organized society. But, it’s not a “commodity” service like garbage collection, is it? Since we do have to look to our tax-paying citizens and employers to pay for “healthcare for all” – the question of course is, how much should each of us contribute to this worthy cause? And who decides how that money is to be used?

Having stirred the pot this morning, I will close by saying – it’s a complex system!

  • There are no “specifications” for inputs (patients who need care come in all conditions and with variation in their genetic, mental, physical, experiential, cultural, economic, and social backgrounds);
  • Processes are highly complex with many stakeholders and overlapping responsibilities
  • There is anexpert-based culture ofphysician caregivers(now expanding slightly to other medical professionals);
  • Outcomes may not meet the patients’ goals through no-one’s fault (you can mostly blame our biologically-based life processes, I guess) but which may in some cases be due to poor care or non-compliance on the part of the patient (for example, not taking medications in the way they were prescribed).

So I just caution you to think carefully about all the proposals that will be floated to “fix” the healthcare system, and don’t jump to solutions too soon on this one.

Is healthcare in its current form in the US perfect? NO! But first I think we have to go back to quality basics and agree on who are the customers, and what is value-added to those customers. I’ve seen many more “solutions” floated, than thoughtful consideration of just what it is we want to get to. I encourage everyone to join this debate from the quality improvement perspective, and to lend your expertise to the discussion!

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p.s. It’s good to be “back on the air” again! Kudos to those at who have been working to resolve the issues that interrupted service over the past several weeks.

Comments 6

  1. Ericonline

    Healthcare is one of the most essential basic services that a government should provide to all of it’s citizens. It is the govenments responsibility to take care of it’s people.

  2. Sue Kozlowski

    Thanks for sharing your thought on this, Eric. And then we must ask – what is the people’s responsibility to take care of themselves? Scenarios:
    – I’m an alcoholic and have cirrhosis of the liver. I need a liver transplant. So my need for $2 million in healthcare services is self-induced. Is it the government’s responsibility to pay for the liver transplant?
    – I’m overweight and have high blood pressure and diabetes. I don’t feel like going on a diet or exercising. Is it the government’s responsibility to provide me with $500,000 of medications and healthcare every year?

    Just some of the thorny issues that we need to address if we’re going to make assumptions about who should do what. Thanks for being engaged in the dialog about health care reform!

  3. Ericonline

    So if you have $2,000,000 worth of medical bills because of self-inflicted ailments and you cannot pay for it, could an honest governement just let you die? While shelling out billions for health-aid in countries on far-flung continents?
    Furthermore, what about your 5 other neighbors that are hard-working, tax-paying, law-abiding citizens that all have some form of cancer or disease and cannot pay their monstrous medical bills? Does it make sense that they are denied help from the government they support? Should 100% of the citizens be denied health coverage because 20% abuse it?
    Why should the government pay for jails then? Is it the peoples responsibility to behave?

    Just a few thoughts!

  4. Mike86

    At some point, every system hits limits. Health care is limited mostly by cost and number of providers.

    The government’s normal means of limiting costs has been to reduce payments to providers. This leads to more providers refusing to treat people being paid for through government plans in favor of those people who are being paid for through private plans.

    The obvious way around this issue is to significantly increase the number of providers and eliminate all insurance. As the number of providers increases, the demand for service will decline, dragging fees downward. Eliminating insurance will force the individual to become more aware and participative in maintaining their health. No insurance also means that provider cost increases must be supported by sufficient increases in benefits. Otherwise, that supplier will drive themselves out of the market place.

    The amazing thing is that none of the programs being discussed appear to be trying to increase the number of providers, just attempting to control / dictate cost or benefits provided and push more people into the system.

  5. Sue Kozlowski

    Eric, you make some good points. Personal responsibility vs government “intervention” is a sticking point in arenas other than healthcare (such as seat belt usage) where well-intentioned people disagree. These types of issues make the debate much more than a dollars-available discussion.

    Mike makes the great observation that the current direction seems to be one-sided (pay less) rather than looking at supply-and-demand factors.

    Thanks for contributing to the great debate!

    Sue K.

  6. Rick Penland

    In my opinion, the government needs to stay in the business of shared services and not get into the business of personal services. Health care does not fall into shared services. If the government gets into personal services, where will it stop? Is the next one the governments tackles going to be feeding everyone, providing travel capabilities, fuel, housing, electricity, automobiles, clothing? The more I hear, the more it sounds like socialism. I believe we should be very concerned when we are letting the government take over any of these individual services. The government is a regulatory body and shared services provider. Do we really want them to do this?

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