The Biggest Problem in Healthcare

My business partner and I have a saying that we use to demonstrate the biggest problem in healthcare.  That problem is that most of the key decisions in healthcare are made at the point farthest away from the patient.  This means that well meaning folks who don’t have a clue about what it takes to deliver quality, patient-friendly care reside in the matrix of decision making at the farthest point from the bedside where we actually deliver that care.  Like politicians, and experts and such.  I’m not saying all nurses and doctors are the very best administrators and policy decision makers, but it would certainly have a different flavor then the politicians trying to transform their world from afar.

Recently I read the Dr. Hsiao’s  report from the State of Vermont.  Vermont decided to get on the Obama agenda and be one of the the first with an all-or-nothing, single-payer healthcare reform bill.  Now they are actually voting on that bill.  So we are clear, Hsiao is a PhD, not a physician, thus reference my opening comment on who is connected and who is not.  The report is full of what I can only describe as, well, do you remember as a kid going to the county fair and having the magician whip out this big tall hat, show it to everyone inside and out, set it down and miraculously pull out a bunny?  That’s it.  Magic.  The report has a lot of magic.

First we cut jobs, and then like magic we create them (no mention of how).  We put more government and decision making and so-called expert analysis into healthcare, and then predict we will have this unbelievably profitable, job-creating, physician-rewarding machine.  Funny how simple this all was!  I just ask you to show me one big or small example of when the government runs something that is awesome, unbelievable, profitable, and rewarding.  I won’t say government can’t create jobs.  Creating federal administrative positions to support all the well intentioned ideas--that they are good at.  Profitable, efficient, and productive--absolutely not.  Just take a tiny peak at the federal budget and you get my point. 

Let’s face it, free healthcare for everyone sounds great.  The problem is it’s simply not simple.  It will cost a fortune, and you and I are going to have to pay for it.  Same as we do now only in a different, and bigger, way.  Today we pay premiums, or in cash or credit, or some, actually many, don’t pay at all.  In our current system under federal law, anybody anywhere in the United States and territories can go into any hospital emergency room, and if you have an emergency medical condition we don’t care if you have a million dollars or 25 cents to your name, you will get treated.  Actually under the same law we can’t even ask you if you have 25 cents.  That’s the law.  Our only worry when you come in is to fix the emergency.  Period.  However, somehow we have to actually cover those costs.  Whether the government takes it over doesn’t matter--we still are going to pay.  Nothing in the system is going to be reduced, nothing is going to cost less.   I hope you aren’t suggesting we pay healthcare workers and physicians less, so the labor costs are not going to change.  Actually if you want to treat your cancer, improve diagnostic capabilities, improve safer surgeries, more detailed, extensive and invasive, and do it all at a higher quality, then actually my friendly politicians, the cost is going to go up.  Of course there is a governmental option and that is to curtail private entrepreneurial innovation, make it harder to invest, explore and develop in a free-market way, you can cut back, tax more, place more burden on small business, and then see if the healthcare world is the same.  The problem is ask any informed, dedicated, healthcare worker who actually directly participates in delivering caring, progressive medicine and they are not going to suggest Dr. Hsiao’s report, Vermont’s single payer plan, more government intervention, or political well-meaning intentions are the answer.

There are a lot of socialized healthcare plans in the world.  Unfortunately there’s not a single example of one that offers access to care, with the level of technical ability, as we do.  None that have our quality of disease diagnostic capabilities.  None that offer the very highest technology and innovation and advanced robotic, mind-blowing ways to keep you alive.  And none that match the motivation that can be developed in healthcare, or any business for that manner, that rewards, invests and nurtures the company and employees.  Go to any federal office in the country and you’ll get to see the difference. 

Actually there is an answer to miraculous healthcare delivery.  It is going on around the world in a dramatic way that can transform healthcare, patient care delivery, customer satisfaction, and improve dramatically the way your health care can happen.  Unfortunately it’s not in a government run, single payer, designed-from-afar utopian work plan.    The answer is less government control and intervention, not more.  The answer is in free-market enterprise, and business models that really get it.  Sustainability, market share growth, and I hate to even say this--let the physicians back in the business models.  Nothing like partnering with an investor who is motivated to deliver the very best healthcare services to the community.

That model will probable be a way off, but let’s be clear about one thing.  Physicians didn’t spend years in training to be pushed around by some governor who turns to healthcare delivery as a way to balance a poorly run government.  Doc’s want to do great work, and are fed up with idiotic plans dictating how their future unfolds.  If Vermont wants to take them on so be it.  Other neighboring states are probably ramping up for the big landslide they surely will benefit from as business and doc’s head their way.  No telling if all these-pie-in-the-sky plans will actually attempt to be implemented.  I sincerely hope not but for now, I guess we all just need to step back, watch all the ridiculous antics,  and think about all the magic...