Visions define us.
Viewpoints alter our assessment of the facts.
Mine. Yours. All of ours.
The more we realize it, the more productive our discussions will ultimately be.
Sometimes, visions affect us so much so that we have no real interest in empirically reviewing what we already want to believe. Evaluating and re-evaluating the reality created by our beliefs intrigues us very little. We prefer to see the evidence that supports our vision. And, we ignore the rest.
A clash of visions plays out all around us—economically, politically, and socially. Here’s one example in the debate over healthcare reform policies.
l’ll begin with this graph from Our World in Data:
The X-axis is health expenditure. The Y-axis is life expectancy. The United States appears by itself at the bottom-right of it. And, here we go…
We’ve been trading freedom for security.
One day at a time.
The former previously defined us—the “Land of the Free”—but apparently that’s less so, now.
They tell us we’ve dwindled down to being the 15th most free nation in the world. Fourteen other countries provide their citizens more personal freedom.
There was a day when someone said if we lost freedom here, there would be no place to escape to. That we were the last stand on earth. But, our actions seem to suggest we find freedom to be over-rated.
* * *
Two things that are frequently misconstrued about healthcare came to my attention after reading a recent article by a writer I respect.
I don’t agree with this author on everything. Far from it. But, she comes across as someone you can discuss legitimate issues with—regardless of your point-of-view.
She’s a self-proclaimed Liberal, who apparently voted for Trump. (Seems she wasn’t the only one.) In her article, she provided healthcare advice to our next President.
My intent is not to refute it. Much of it, in fact, I agree with. But, I want to elaborate on two things that came to me after reading a quote in this article. I will examine the concept of (1) shopping for healthcare, and (2) how it relates to your life.
Here’s the quote:
It’s business as usual at the office.
Another Fall season is here.
It’s time, once again, to sort through all the madness.
I wish it were “Midnight Madness.” Because, I like college basketball. That’s the name we give to the first formal practice of the season. The one where you get a glimpse of your local team’s talent.
Unfortunately, that’s not what I’m talking about at all. But, there are some similarities.
For example, the madness (I speak of) spans numerous midnights and deals with a practice—albeit a physician operated one.
My office is currently back at it again trying to figure out how we can continue to see Medicare patients. One day soon, we might just give up. But, if you are one of my Medicare patients, don’t call me in panic. Call your congress member instead. Click here if you don’t know who that is.
My recent post appeared to catch the attention of Mr. Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS):
My article recapped another day of insanity within our healthcare enterprise, and yes, taking a look, Mr. Slavitt, would be greatly appreciated.
Choosing to see, however, is my challenge for you—for as a friend reminded me, you seem to be very good at “feeling our pain.”
But, I must admit, thanks to you, I was contacted by a CMS official overseeing the startup of MACRA.
For those that don’t follow healthcare policy closely, MACRA is our government’s latest medical project. Another soon-to-be-implemented healthcare law with 962 pages of rules, including the most recent method devised to pay physicians, something known as the Merit-Based Incentive Payment System (MIPS).
CMS was seeking my perspective on MACRA and MIPS.
My written response to them—edited only somewhat for brevity—is shared below:
I arrived with my family. I handed the usher our tickets.
We entered the auditorium. The stage was lit. We were directed to our seats.
We were there to watch an OPAS Junior production—a performing arts play for families and children.
The performance would soon be what we paid for, an enjoyable Sunday afternoon event with my wife and boys.
The actors and actresses did their job. They appealed to us, the audience. They danced, sung songs, provided humor, and so forth. They were there for us that day. And, we were there for them.
We paid for their performance. And, they gave us one.
* * *
A compelling strategy has consumed American healthcare. It’s known as pay-for-performance. It’s trying to replace our unknown fee-for-service model, because it seems more logical.
Sometimes perspective is helpful.
Even when given just a little bit of it.
Presidential candidate, Sen. Bernie Sanders, has recently released his “Medicare-for-All” plan. Similar to his make college education free plan, there are a number of things admirable about it. No healthcare deductibles. No co-pays. No fighting with insurance companies. We all get, seemingly for “free,” whatever the government thinks we need.
And, I get it. In 4th-grade, I once ran for student council touting a “No Homework For All!“ slogan. I’m not even saying this is the same strategy being used by Sen. Sanders. Instead, I’m just trying to imagine the ideal:
A world where all of us have (1) the healthcare we need, (2) when we need it, (3) at the most reasonable cost to all of us, collectively.
There is a single CT scanner in town.
A certain number of scans are done with it each month.
Suddenly, a second scanner is installed at a new location across town.
True or False:
The total number of CT scans being performed will remain the same with two scanners now available.
The answer is false… at least within our current system. Someone has studied it. Adding another scanner increases the utilization of scanning.
Is this a good thing or a bad thing? Careful, now. It’s an entirely different question. The answer, of course, is maybe, or maybe not. You need more information.
Healthcare insurance deductibles have increased seven times faster than wages in the last five years.
In case you missed the memo already sent to your pocket book, our system is not designed to help anyone afford quality care.
Few understand it. How it works. Who controls it.
Most of us just accept it.
Maybe, it’s because we’ve led ourselves to believe a world cannot exist without having a Food and Drug Administration (FDA) to protect it. America’s unregulated $37 billion vitamin and supplement industry may speak to the contrary, but yes, we seem to sleep more soundly believing there is a watchdog on our front porch.
It would be ideological suicide to question what’s really there.
And, so we believe. Me included.
It is absolutely absurd to reward someone for being less productive.
This entire principle is befuddling to me.
But, a government think tank has decided this is the future of American medicine. “We’ve discovered a better way to muddle with the healthcare market,” they say.
The previous (and also ridiculous) system, built upon an UNKNOWN fee-for-every-service, is now being replaced by a more accountable one.
Accountability, like safety, is an easy concept on which to build support. Why? Because we need accountability in healthcare.
If the term, Accountable Care Organization (ACO), is not commonplace for you yet, it will be. In fact, you may already be receiving your medical care from one right now.
ACOs are networks of doctors, hospitals, and other medical providers that share responsibility in the care and cost of a large population’s health.
Think of them as being the It.
And, It may be caring for you.