Health Care and the Anxiety of Efficiency; A Short Explanation of a Huge Problem

Neither President Obama, Congress nor the advocates of health care reform have made a compelling, practical and easily-digested case for how anyone can find enough savings in the system to extend coverage and reduce inflation, without sacrificing the level of care that many people are satisfied with.

They claim they can do it, but the argument against it -- rationing, delays, inadequate care, the worst of Canada and the U.K. -- is more poetic, fear-inducing and tangible than the argument for reform. Nobody thinks that our system is flawless, but there's a long cultural history, in movies and TV, that mocks stereotypical, clipboard-wielding efficiency experts.

We also get nervous when we hear talk about "efficiency" because the truth is that we are quite fond of many of the inefficiencies in our health care system. They make us feel confident. Protected. Important. And comparing protocols based on some grading system activates everything we've learned to loathe about monsters of standardization, from the SATs to the IRS.

So if it's inefficient on a macro-economic level to give a 35 year old asymptomatic male with a family history of heart disease a nuclear stress test -- but his conservative doctor feels the need to do that -- most Americans would probably think that's just fine. Behavioral economists constantly tell us that our brains aren't built to understand mathematical concepts like percentages and fractions. But fear requires no processing; it sets off the amygdala , the most primitive part of the brain.

The president is fighting an amygdalic war with PowerPoint logic. That's a losing battle. He and the Democratic Congress are basing their central economic argument on abstract modeling and forecasting projections. The data may say that we can save billions by eliminating waste, inefficiency and redundancy, but we don't buy this theoretical exercise. (After all, wasn't it models and forecasting that got us into the subprime crisis?)

We have no cultural framework or anecdotal memes to support the argument that health care efficiency is anything but a brutal surgery without civic anesthetic. On the other hand, we have been programmed to believe that in the world of health care, cutting costs ends up hurting people when clinical standards are applied to human realities.

Right now, our health system is very much like our judicial system. The latter is based on the belief that it's okay for ten guilty men to go free so one innocent man doesn't go to jail. And our health system says that it's okay to spend money on screening healthy people to identify the small percentage that's sick.

So health care reform advocates need to drop the inefficiency language and re-frame the argument as "We're going to bring common sense to cost-savings." Offer examples everyone can relate to. Talk about how we wake up every patient in the hospital to take their temperature, even though less than ten percent of people need their temperatures to be monitored. Remind people about how they have to fill out the same form over and over again. Use language like "take money from the bureaucracy and reinvest it in tests and preventative medicine that actually help people -- rather than following outdated protocols and rules."

Health care advocates have made it easy for Sarah Palin and others on the right to convince too many people about death tribunals and other imaginary state interventions. But unless they understand why their plan is so vulnerable to distortion, they won't be able to fix the way they're trying to sell it.

Comments

[sabredance]

Great comment and spot on. I agree: the Dems and Obama have failed to put a human face on the health care problem, failed to vilify effectively the insurance industry, failed to make a compelling narrative or anchor their arguments in emotion (logic is present in plenty). You can't sell to people without doing these things no matter the math.

[dadw5boys]

Let's see just by reducing the paper work that HMO's demand of Doctors there would be a savings of $910 Billion Dollars each year.

Then allow Doctors to treat the cause of the illness with test and not hust treat the symptoms with a pill then another pill then aonther pill.

Stop the BUM RUSH health care and actually provide MEDICAL CARE there is a difference between HMO Heath Care and actual Medical Care.

Bum Rush health care = Doctor office calls the Elderly saying the Doctor is going out of town and wats to see you before he goes. Patient come in has a blood test and soon after the Doctor come in and ask " Is everything Ok?" If the answer is "yes" the Doctor is out the door in seconds and gone.

The medicare is bill $90.00 for the office visit and $40.00 for the blood test.
An Elderly person who did not need a Doctor's appointment or want one was ordered in by their Doctor so he can bill medicare. That is what Mdicare is facing today.

How many Elderly patients does it take to pay for a Eroupean Vaction ? A vaction home at the beach?

[freshnotbitter]

Actually it is ok to say we need efficiencies so we can deliver more health care for the same dollar.

More health care. Not less. That is what we mean when we say efficiency. (For the technically minded, efficiency is simply output/input or amount of medicine per $.)

Cost savings sounds good but at the end of the day you will be taken to the cleaners with that language.

Efficiency doesn't mean you reduce the number of tests you give, it means you increase them because they save money.

I have always said that politicians would be surprised to see how much the public is willing to spend on health care. The minute O started talking about reducing fees for medicare procedures to produce "savings" so he could sell more insurance policies for the corporations he was toast, not to mention the whole thing about reducing tonsillectomies.

I would have said we can save money best by spending money. Spending money on prevention, obesity reduction, screening clinics, automation projects, fraud prevention­,etc., etc.

Then I would get my Truman on and give them hell when they asked "where are we going to find the money?"

The White House doesn't understand how to sell health reform because they don't understand the importance of it to the individual.

[PaxEterna]

They don't understand the issue, and didn't during the campaign, no wonder they are totally fumbling this play.

[mbaty]

I agree that Democrats, and specifically Health Care reform advocates, need to work on their "sound byte" skills when dealing with the MSM. It's easy to frame the debate around short phrases with exclamation points. What I was struck by is your assesment of the judicial system being, essentially, soft on crime so that innocent people don't go to jail. Have you looked at the figures? We lock up many many people who don't really deserve it, sometimes for years just because of a technicality or a mandatory sentence. We lock them up for imbibing certain non-pharma approved chemicals, many of which grow out of the ground, and then certain other people make a profit depending on how many people are locked up. This isn't actually being "soft on crime," it's just a mockery of the word "justice" and an excessive use of detainment for practically every offense--plus hefty fines that, we're told, deter people from committing such offenses.
I know this is a bit off-point, but Health Care and the justice system are both largely for-profit endevours. And applying Capitalism to either is just counterproductive. Let's actually solve these problems instead of just incentivizing their perpetuation.

[ahanft]

You are right about the current practice of law enforcement. But I am talking about the myths that we tell ourselves, our civic folklore, and part of that is the notion that the presumption of innocence (vs the British presumption of guilt) is an American value. The analogue in health care, as I see it, is that some healthy people will have too many health care dollars spent on them, to make sure some sick people are identified and treated. It may not work that way in practice, but unless you address the belief structures we have, we'll never improve the system.

AHanft