As I have said in previous posts, The U.S. healthcare system is fundamentally broken in that the forces of market capitalism are disengaged from the delivery of healthcare. And I agree with Rick Jackson, in his comment, that the economic incentives are misaligned resulting in a system that violates the basic laws of economics.
Adequately addressing this issue is going to require true bipartisanship effort, and the political intestinal fortitude to shut down (or at least redefine) the health care benefits industry (Aetna, United, etc.). But, what do we do while we wait for our politicians to do the right thing?
I believe we could dramatically improve the sate of healthcare by transforming hospital operations and in so doing liberate $25 to $50 billion annually. Additionally, and just as importantly, a meaningful operational transformation should greatly reduce the 44,000 to 98,000 deaths and $17 to $29 billion attributable to avoidable medical and pharmaceutical errors (IOM 1999 Consensus Report).
Hospitals can be transformed, and in future posts I will share some thoughts about how that transformation can be achieved and report on a few success stories.
Now I want to be clear, I am not bashing care-delivery organizations or providers. I believe that they are the inheritors, not the cause, of what Bill Franklin described as an accidental healthcare system that would have made Franz Kafka proud. I guess what I am asking is, if there is a better way -- especially with the stakes as high as they are -- aren't we compelled to pursue it?
So, I ask again
If one could transform hospital operations, conservatively liberating up to $42 billion annually and reducing the 44,000 avoidable deaths due to medical and medication errors, doesn't it become a moral imperative to do so?
If you agree, how do we move the public debate toward answering this question and others that could actually make a difference?
If you don't agree, set me straight.
Hmmmm. Interesting way to frame the issue.
ReplyDeleteThere are 150,000 stroke-related deaths per year and 500,000 heart attacks, 20% of which cause death. There are over 40,000 deaths from breast cancer each year. Eighty-six men die from prostate cancer every day. Five children die from child abuse EVERY DAY.
Is there a moral imperative to do something about any preventable death? Abolutely. Human life is valued, and the pain and economic consequences of the loss are immeasurable. But is that the way to argue for improving hospital operations?
Governmental waste in this country is incomprehensible and probably unquantifiable. But the same is true in private sector organizations. Taxpayers pay for the first, and customers pay for the second. But is that the way to argue for improved hospital operations?
There are about 30 million hospitalizations in this country and a population of about 300 million. So about one in ten will be hospitalized. Not a large percentage (unless you're one of the 10%) so some could say, "What's the big deal?" But is that the way to argue for improved hospital operations?
It seems to me (opinion) that if one wants to improve hospital operations, there will always be a rationale to argue from -- moral imperative, economics, social responsibility, whatever.
In his book Excellence (published in 1961; I read it in 1965), John Gardner argued, "We must ... honor excellence (indeed demand it) in every socially accepted human activiy, however humble the activity, and scorn shoddines, however exalted the activity. An excellent plumber is infinitely more admirable than an incompetent philosopher. The society which scorns excellence in plumbing because plumbing is a humble activity and tolerates shoddines in philosophy because it is an exalted activity will have neither good plumbing nor good philosophy. Neither its pipes nor its therories will hold water."
Things should be done right because it's the right thing to do. It needs no other defense than that.
Bill,
ReplyDeleteThank you for the comment. Among other things it reminded me that I should be very cautious before getting on any high-horse. I am certainly guilty of ignoring any number of moral imperatives and, as you say, things should be done right because it's the right thing to do.
Having said that, when the right thing does not get done, or feels too hard to do, or is given-up on, I may resort to asking if there is a moral imperative at play as a device for drawing attention to the issue… is that inappropriate?