The year is 2014. I had this dream the other night of having dropped my IQ when I was at the hospital, but I couldn’t remember which hospital, so off I went, hospital by hospital looking for my IQ—I realize there are those of you who believe this isn’t a great loss.
In the first hospital I visited, a photo of the new president hung behind the registration desk. Next to her photo—surprised some of you with that I bet—hung the photo of the Secretary of Hospital Sameness. For a while I wondered what someone in that position did day to day. The more hospitals I visited, the more apparent it became. The hospitals all looked very much alike, right down to dust on the fake Fichus tree next to the water fountain. For a while I thought that maybe I was driving in circles until I noticed that even though receptionists were all named Gladys, they wore different clothes. It was almost like visiting Stepford.
Does anyone have the sense that what reform will really accomplish is to reform away healthcare competition? There appears to be a move afoot towards the efficiency that is created by sameness—what I call the McDonalds healthcare model. Put one on every corner. Make them identical. Limit the options. Everyone gets a burger. Nobody gets a steak.
Eliminate waste. Does that mean eliminate ways of operating that differ from how the government permits them to operate? There is talk of pulling costs out of the system thereby making it more efficient. You tell me. Is the argument that there is so much inefficiency that by becoming efficient not only will we be able to cover everyone, but we will be able to do it at a cost below what it costs to care for far fewer people?
How do you understand it? Are costs being removed, or simply moved? If someone with no access to healthcare suddenly has healthcare—a good thing by almost anyone’s standards—the reasoned person knows costs have just increased. (Healthcare theorem 1: The cost to provide healthcare to 2 people is greater than or equal to the cost to provide it to one person.) If costs have increased, how does one make a believable argument that the basis for reform is cost reduction?
I try hard not to be too cynical, but sometimes I think, why bother. By the way, I found my IQ. Thanks for asking.
Chief Imaginist, Healthcare IT Strategy
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