Rejecting Mr. Quicksolve

We live in the moment. We live for the moment. We demand instant gratification. We expect immediate access. Think cell phones or the Internet, or better phone calls through the Internet. When we are sick, we take for granted a quick cure. Take this. Do that. You will be fine in the morning.

It is consistent - though completely unrealistic - to have the same expectation when fixing our healthcare system. Legislate a single payer system. Mandate universal health care. Everything will then be fine. To paraphrase Judith Rossner's 1975 best-selling novel about Mr. Goodbar, we are all Looking for Mr. Quicksolve.

There are problems.
• Mr. Quicksolve does not live here anymore. In fact, he is like George Kaplan in Hitchcock's classic film North By Northwest: Mr. Quicksolve does not exist (and never did).
• Accepting a quick solution means that we are addressing symptoms not causes.
• Quick solutions do not work and often make things worse.
• Quick solutions take away needed resources from solutions that actually might work.

We are not babies but we sometimes act like them. We need to wean ourselves from magic thinking. There is no silver bullet or secret potion.

In our heads, we know that longstanding complex problems require complex answers over time. In our hearts, we want what we want when we want it...and we expect to get it.

There are numerous things fundamentally wrong with our healthcare system. Right now the media has focused our attention on the financing, as though that were the only problem and worse, implying that fixing it would solve healthcare.

46 million without health insurance. Medical bills a leading cause of bankruptcy. Annual healthcare expenditures approaching 20% of U.S. GDP (over $2 trillion). These are big problems but keep in mind two things.

#1. Even if you could wave a wand and fix the financing [you cannot; no one can], it would not assure you of high quality, easily accessible healthcare. For instance, all the money in the world will not get you health care if there are no nurses or doctors.

#2. Financing does not exist in a vacuum or a silo. It is part of an interdependent system. Changing one part in isolation does not fix systematic problems. It usually makes them worse. Will fixing one bank fix the current economic crisis? If you simply mandate universal health care, without checks and balances, the cost will skyrocket further. If you impose cost controls, access will plummet. No so easy is it?

Healthcare's problems are not insoluble. I am not and never will be a member of the "consensus of futility." We can cure healthcare but we must practice good medicine...on Sicko. That means making a diagnosis that includes the causes not just symptoms, treating those causes, and accepting that a cure will takes years to decades. If we accept Mr. Quicksolve's answer, healthcare will never be right. If we start now, it will certainly be "right" for our children. If we had started to do it right in the 1950's, healthcare would be right, right now, for us.

The sooner we stop listening to the seductive Mr. Quicksolve and start curing healthcare, the quicker we will have the healthcare we need.

PS. If someone offers you a solution that will fix healthcare in the short term, that person is: a) A politician pandering for votes; b) A self-styled expert selling books or trolling for speaking gigs; or c) Someone who simply does not understand. In any case, reject their so-called answer because it will not work.

Comments

[Deane Waldman]

07:50 PM on 02/24/2009

Magen,
If I had to point to only one issue that dominates the reasons for healthcare dysfunctio­n, other than "flawed system design," it would be the timeline issue that you put your finger on.

We measure only immediate costs. never long term anything (like benefits or even costs).

We really do expect instant cures for: medical problems; administra­tive hassles; financial woes; personnel shortages; 11 hour wit times in the ER; 46 million w/o health insurance (not without health CARE); and most fundamenta­lly, not looking down the road.

There are many who expect our new President to fix the current economic turndown (that took 30+ years to develop) w/i a year and to solve healthcare shortly thereafter­...and if he don't, then throw the bum out and get someone who will. No thought to beginning a process leading to a real cure: what our grandparen­ts should have done about healthcare­. Had they seen the obsolescen­ce of the old mental models ("one ill; one pill; one bill" approach to health care), they would have started to steer health care in an appropriat­e direction and we now would ne the beneficiar­ies. Honestly, if we do it right, our children will have a great healthcare system, but maybe not us, certainly not for 20 years.

Treating causes -- not symptoms as Mr. QUicksolve does -- will cure the patient but that takes T I M E.

[Deane Waldman]

07:39 PM on 02/24/2009

I am pleased to see discussion­, particular­ly disagreeme­nt. That is what we need: open dialogue about what is wrong, what is right and what should be done.
In essence, I read from the above, you suggest that ll legal residents of the US join the VA system and the rest...don­'t get care (at all)?
The matter of over 10 million "illegal aliens" (alien...f­rom Mars? another galaxy?) is contentiou­s in deed polarizing with a complexity that precludes a Mr. Quicksolve answer. Three things I know: 1) illegals are human beings; 2) most pax taxes and have been here for a long time; and 3) the issue will only be equitably resolved by frank OPEN discussion and action after consensus, never by fiat.
While I give the current VA administra­tion high marks for trying to make improvemen­ts, they are all from above and more important, the VA model cannot be expanded to general, acute hospitals, especially to non-compli­ant patient population­s. The VA system is rule-bound­; risk averse and anti-innov­ative; purely top down managed; and having no experience with the issues facing modern urban hospitals and health care systems.
Finally and most important, if we do not re-connect the consumer and payer, we will never get control of the healthcare cost spiral. The VA system cannot do that.

[disintaGreatNation]

02:41 PM on 02/24/2009

I respectful­ly disagree. The federal government should issue a special DD-214 to all legal residents of the U.S. That federal form would allow the holder to receive treatment at VA hospitals and clinics. Next, the federal government should encourage all private health care providers to become part of the VA fee-basis system, and it should constrain those who do not.

[magen]

02:35 PM on 02/24/2009

Running to Mr. Quicksolve is one of the root problems of the fall of America.

What issue does America NOT run to Mr. Quicksolve to put a band-aid on????????­??

The countries that have long-term solutions to long-term problems and have forward progressiv­e thinking policies instead of just reacting to problems in the short-term will do well.

Once upon a time, we had thinking like this in America.

But it's been replaced by the philosophy of----It's all good as long as it makes a lot of money quickly, no matter who gets effed or what it destroys.