As I looked out the window in Massachusetts this morning, everything seemed the same. But, from what I read and hear, everything changed on Tuesday night. That's confusing.
The confusion started as a red Republican, Scott Brown, threatened to take Ted Kennedy's bluest-of-blue, Democratic Senate seat. Then, on Tuesday, it happened - Brown won. Now, it's Mass. Confusion as the Boston Globe headlines "A New Political Landscape," and the Wall Street Journal quotes a Senate aide saying, "People are hysterical right now."
But is everything really so confusing? I propose that kind of thinking is a big part of our current health care problem. For lack of a better term, let's call it Mass. Health Care Confusion. Here are some examples:
Mass. Health Care Confusion #1: The big health care problem requires a big solution.
I agree with President Obama: "The biggest threat to our nation's balance sheet is the skyrocketing cost of health care." That's a big problem. It's the "big solution" answer that I question.
I have been in health care for 40 years and "big problem = big solution" has always been the health care expert's mantra. But those "big solutions" not only haven't worked, they've become part of the problem (see When Healthcare Solutions Become Problems)
H. L. Mencken once said, "For every difficult and complicated question there is a answer that is simple, easily understood ... and wrong." If you think that way, it's all a little less confusing.
Mass. Health Care Confusion #2: Health care needs a big, quick, political solution.
Adding politics into the "big solution" equation increases the confusion, makes it more challenging to find answers and more burdensome to govern.
For example, prior to his election President Obama campaigned heavily to allow Americans to purchase lower-priced, FDA-approved medicines from overseas. That's not a bad idea, but his administration eliminated that initiative from health care reform. Why? - "It's about being a candidate as opposed to being a president," said the drug industry's top lobbyist (See Candidate Flip, President Flop) . The White House commented that disenchanted activists "need to take off [their] pajamas, get dressed, and realize that governing a closely divided country is complicated."
I find that comment refreshingly frank. Political realities are big complex problems in and of themselves. It all becomes less confusing when you realize that combining two big, complex problems like health care reform and politics together, makes it that much more difficult to find solutions and govern effectively.
Mass. Health Care Confusion #3: Obama and the Democrats are wrong and the Republicans are right.
That's just another simple explanation to a complex problem and just as wrong.
The accelerating cost of health care and the uninsured are crucially important issues. The Rush Limbaugh-types and others who use any and every Democratic policy initiative to inflame partisan ideologies or the apologists who chant "our health care's great" only add to the confusion.
It decreases the confusion when we realize politics and health care did not radically change on Tuesday night, only the realities of both became much more obvious. This is an opportune time to reduce the confusion and find common ground in the center of both parties to generate policy that can really make a difference for patients.
We can further decrease the confusion by being more specific about the problems and potential solutions. Here are my thoughts:
The way we are currently practicing, managing and governing health care is delivering much less care at much more cost, and it's getting worse. We can't afford that trade-off for economic and humanitarian reasons. That's a big problem with many causes. Experts have designed big, top-down health care solutions for forty years. They haven't worked. Add politics into the equation and it only gets more confusing. We need an alternative.
So what's the answer? Health care needs to transform and, in my and others' research, industry transformations follow a predictable course: a few leaders progressively adapt their organizations to deliver what the rest cannot. Toyota did not design and implement the Toyota Production System or the downfall of GM; they made it through constant adaptation. Southwest Airlines did not design and implement the world's most profitable airline; they made it in a similar fashion. Those are just two of hundreds of examples.
Health care transformation begins with those few organizations that become strategically and operationally "designed to adapt." They gain advantage in a rapidly changing world by adapting to create innovations that deliver more care for less cost. Here is how it works:
The seeds for this transformation are already planted. Rather than designing and implementing the answer, a few health care organizations are seeking to build organizational DNA that is "designed to adapt." We need to nurture and spread those seeds (see Beyond Politics - Making a Difference in Healthcare Now)
Both government and the health care industry have become wedded to leading "big fixes." Too often that becomes a confusing, discouraging "flavor-of-the-month" at the point of care. We will eliminate confusion in challenging times when leadership revitalizes trust, optimism, high-performance and innovation that makes a difference for patients.
Government has a crucial role to play in an adaptive health care reform. Confusion can be diminished by policy initiatives that create safe-harbors for innovation at the grass roots level and eliminate obstacles and barriers to improvement. That's the way government has always successfully facilitated significant social and economic change. That will help eliminate Mass. Health Care Confusion and start to make a difference for patients.
Dr. John Kenagy is a physician, patient and former Visiting Scholar at Harvard Business School who speaks and advises on health care transformation focused on the patient. His recent book is Designed to Adapt: Leading Healthcare in Challenging Times. For more information, see www.johnkenagy.com.
Follow John Kenagy on Twitter: www.twitter.com/johnkenagymd
I'm an independent. I have no allegiance to either political party. I was, and am, in favor of reform, it will happen, with or without government help. The question is how much human damage and waste occurs before costs escalate to the point that they are entirely unsustainable.
Candidate Obama promised to lower cost, the current bill did not do this. At best it shifted costs, or tried to hide them, but lowered? No.
Candidate Obama promised transparency. The House and Senate (especially Senate) were hardly transparent in their actions. Their motives were quite transparent. Special interests were pandered to at every turn.
Candidate Obama spoke of change we can believe in. It is why he was elected. Now President Obama needs to step up and put action to those fine words.
The US health-care delivery system is insurance-based, except for emergency services (even Medicare is insurance). No amount of "organizational DNA" within delivery organizations is going to provide routine health care to the tens of millions who are currently uninsured, nor is it going to address issues such as denial of insurance for pre-existing conditions. These are problems that reside within the health INSURANCE industry, not the health-care PROVIDER industry.
Without some fairly "big solution" reform of the insurance industry, your ""Adaptive Design" changes may well reduce overall health-care expense, but the benefits of the improvements will be restricted mostly to those people who have group insurance through their employers.
I'm including a link to a HP page where I have comments at the bottom on how Healthcare IT can be used to solve the problems, save 1.3 trillion a year and can be scored by the CBO.
http://www.huffingtonpost.com/steve-ballmer/improving-government-serv_b_423088.html
These technologies are already being used at Cisco, McKessen, IBM and the DOD. Once you understand the technologies I use you'll see it exactly matches your Adaptive Design once we've created a flexible infrastructure.
1. You are on target in your Ballmer comment about current healthcare IT. The problem is not a shortage of data, it's getting the right data to the right person at the right time and place. Current healthcare will not deliver, see
http://www.huffingtonpost.com/john-kenagy/ensuring-investment-in-he_b_221054.html
2. You undoubtedly have tremendous IT expertise, however, the problem I struggle with is not technological. Current healthcare is several orders of magnitude more complex, dynamic and unpredictable than any other business I know. Traditional industrial process management methods can't keep up and digitalizing that complexity just makes it worse. Adaptive Design starts to make the unpredictable information needs at the point of care much more understandable. When we understand the work, than your technological expertise will help us build the IT architecture that will sustain, spread and accelerate the gains. But first we have to understand the work beyond current "Best Practice."
Point 2, although I talk about workbooks the medical provider would be presented with an editable Word or pdf document that allows for added registered observations or categorization. The idea is that I don't believe we actually really know precisely what Best Medical Practices are but we should find out. This is why the paradigm that I think works is a structured document where only parts of the document can be validated but never the whole document. The other thing is that adaptability suffers at the first database up the hierarchy that is why for the system to learn and adapt the databse should be at the telecoms.
Expanding Medicare for All would be the simplest solution. Yes, Medicare tax would have to be raised, but in the trade-off in insurance premium, most people would be paying less overall. The insurance companies would lose, but it would be the best economic stimulus for the people by relieving the crippling costs of medical care today.
We will solve the "insurance problem" as we create highly adaptive healthcare delivery that starts to get it really right for patients. In my experience, we waste at least 50% of what we spend at the point of care and people still don't get what they need. Solve that and you have a powerful base on which to develop new products and services linked to more effective care. One of those new services with be simpler, more rational, most less costly insurance coverage.
This is not a dream, it's the way industry transformations always happen. Nor is it complicated; it's just different.
For the last 40 years, we have identified big problems in healthcare and treated them with big solutions. That has always failed, so we just moved the ante up higher and said, "Government fix this big big big healthcare problem." And now its failing again because, in fact, there are no big problems - only aggregations of thousands and thousands of small problems tied to the needs of individual patients. Your examples break down to 4 or 5 huge categories: cardiology, lifestyle disease, care of the aged, total joints, palliative care, etc. Still way to big to do anything about.
So here's what's different about my work. I help health systems start with individual patients and work back, not take care of a "population" from the top down. You can build systems from the patient up. It's not rocket science, just very different. But it is the only way to solve the problems you identify. We have examples and proof, quietly developing around the country. It's a disruptive innovation, so it does not fit the way we currently think and act. If your interested, get the book - it will help you see. I'll be writing more this year. thanks for the thoughtful comment. Stay tuned.
Oh, and you are correct - there is a MIC and that is part of the problem.
Few in media and such, still haven't realized that 200 million in employer based plans get nothing but a few crumbs like waived pre -existing conditions, etc. The insured in employer based plans get no cost control protection. The notices are already in the mail for 15%-19% premium increases. (this can be verified).
Smart Democrats realize that there is now no Public Option for employer based plans. Obama campaigned on Public Option for everyone. He didn't say that the PO was only for the uninsured. For 11 months all we have heard is the public option. The polls taken showing that 60% to 70% favored the PO. The wern't asked "do you favor the PO for the uninsured".
This is nothing more than bait and switch. The current insured get no reduction in premiums legislation and get to subsidize the premiums for the uninsrued. And the insurance industry gets 30 million new customers.
As an insured in an employer based plan, I could care less what they do with this HC bill at this point. I am sick of hearing about it. The Democrats sold out to the insurance companies and now they want us to believe that they have done such a great job with this worthless legislation. I will now campaign against all incumbant Democrats.
Politicians are elected to solve problems. So Democrats, flush with victory, say, "We'll take healthcare on and fix it!" (W tried the same approach in Iraq)
So who do they turn to for advice? The experts who got us into this mess. What's the experts' advice? - "Try harder with more big fixes."
I don't want to be cynical. I have great respect for everyone's commitment to make a difference. Many dedicated, intelligent people are convinced a big, top down fix is the answer. But the evidence shows they fail or are not politically feasible.
Scott Brown showed how "the wisdom of the crowd" is greater than the experts. And now, the "smart Democrats" are catching on. It's tragic -- but it's politics.
I know we can solve the small problems that aggregate to form the big, unmanageable ones. It means focusing on the patient and capturing the knowledge and creativity at the point of care.
The concepts of Adaptive Design are simple, just different. "And therein lies the rub." That's why I write books, blog on Huff Post, and work at the point of care to make it better for patients. Soon, we will have enough evidence to get Smart Democrats and Smart Republicans on board.
If it takes another 10 years for a chance to get this done that's about 500,000 men, women and children in America dying for lack of insurance. But in America, whether conservative or progressive, it's 'I got mine, Jack. Screw you.'