The further to the left or the right you move, the more your lens on life distorts.

Tuesday, June 09, 2009

A Better Prescription

Those of us in the center who dare to question President Obama’s rush to institute a comprehensive reform of the nation’s health care system are met with incredulity by our progressive friends. “How can you say our health care system is broken when 47 million people are uninsured? It’s a travesty, an embarrassment!” They exclaim. “After all, look at Canada or the UK, they’ve had national health care system for years and they work well …”

But if we suggest that there is a need for thoughtful, more controlled modification of our healthcare system, some on the Right suggest that we’re in favor of creeping socialism. “Do you really want some bureaucrat coming between you and your doctor?” they ask, brow furrowed with concern.

In this case, both the Left and the Right are wrong.

There is little debate that our medical insurance system is wasteful, overly expensive, and rife with fraud (particularly in those parts of the system that are currently administered by the government). But it’s also true that the system is enormously complex, very, very difficult to change, and predominantly effective in serving the medical needs of almost 90 percent of the American public.

I recently spent a week with colleagues from the UK. Over dinner one night we discussed our respective medical systems. True, their medical insurance is bundled into their taxes (it is not free), but care is rationed to the extent that it’s not unusual to wait for months to get an MRI (a test that is available next day in the USA), more months to see a medical specialist, and years for elective surgery. In effect, the government-run program in the UK tries to control costs by rationing care.

More interesting is that there is a growing trend in the UK back to private medicine. The same is true in Canada. So, here we have universal health care programs in Canada and the UK that recognize the shortcoming of a one-payer system and are slowly transforming themselves back to the US model, while we have an administration in the USA who is trying to transform to US model into the Canadian or British systems that really aren’t working very well.

Even more troubling is the speed with which the Obama administration wants to accomplish the job. The President has declared that he wants effective, all encompassing health care legislation on his desk by October. That’s like saying that you’d like your 4 year old to graduate from college no later than 2011.

Speaking as a systems guy, health care is a really, really, complex problem. It is in need of change, but the change should be done in stages, should focus on targeted areas of opportunity, should establish clear, non-political metrics to assess the efficacy of what small changes are made so that (1) they can be discontinued if they are ineffective or (2) tweaked if they’re close but not fully effective. Lastly, a comprehensive risk analysis should be performed before even the smallest change is to be made, so that the impact of unintended consequences can be ascertained before billions are spent and people’s live are put on the line.

Obama supporters keep telling me he’s a really, really smart guy. That may be true, but he’s certainly not a systems guy. In fact, nothing in his background or experience or current actions indicates that he truly understands the complexity of the changes he’s trying to rush through. In fact, it appears as if he’s being just a bit impetuous in his demand that full legislation be developed in 4 months.

Does our health care system needs to change to meet the demands of 21st century medical care? It does. Does it need radical change implemented with little thought and even less consideration of the consequences of that change on the 90 percent of the public. No, it does not.

For once, let’s take our time and do it right.