East of Eden: Why Health Care Got Hijacked

The "Eden Myth," deeply rooted in American culture, is one of the reasons why health care has been hijacked by a vocal minority.

Perhaps as a result of American Exceptionalism--the idea that we have a unique and special place in the world--we too often view the past as the Eden from which we have been expelled.

John Winthrop said to the Puritan colonists of Massachusetts Bay:

For we must consider that we shall be as a city upon a hill. The eyes of all people are upon us. So that if we shall deal falsely with our God in this work we have undertaken ... we shall be made a story and a by-word throughout the world.

Many of the health-care protesters at town halls avoided talking about preexisting conditions, insurance bills or doctors, and cried out, "I want my America back."

Exactly which America they were talking about was unclear--maybe one where a white guy was always president--but the language was strangely apocalyptic. Somewhere, sometime in the past, we were a city on a hill and have gone downhill from there.

Those lingering ideas about a vanished Eden may be the reason why many people are buying the notion that a health care bill could be an invitation for a vast government takeover. It's rather odd, because the history of American health in the past was anything but a Garden of Eden. Before the modern era, plagues swept through and decimated whole villages, the Spanish flu killed millions, women died regularly in childbirth and any soldier who went off to war was more likely to be killed by infection than by an enemy cannonball. We didn't need "death panels." Nature did the job splendidly.

Because of American exceptionalism, we tend to prefer high-flying rhetoric to the dull business of nuts-and-bolts legislation.

Morning in America
, The Audacity of Hope and the New Frontier fall trippingly off the tongue. The mundane details of such things as cost containment too often elicit a yawn. But when it comes to health care, the devil is indeed in the details. How do we bring down the soaring costs of care?

The secret, says Clare Crawford-Mason, producer of the PBS documentary Good News...How Hospitals Heal Themselves, lies in the way hospitals are managed. "The American hospital, the center of health care, is a cottage industry in the post-industrial world," says Crawford-Mason, "and we can save billions of dollars by bringing them into the modern world."

Crawford-Mason was the producer of the NBC White paper "If Japan Can, Why Can't We" in 1980. In the course of making the documentary, she met W. Edwards Deming, the man who taught Japan how to work smarter. Deming showed the Japanese how systems thinking could replace competition with cooperation, eliminate the "blame game" and produce continual improvements in quality.

Deming wrote:

Unless all the individuals and departments of an organization share a commitment to a single unifying purpose or aim, there can be no system. Without a single shared purpose, the organization is a collection of individuals each with his or her own agenda and collections of departments each pursuing its own purpose. A single shared purpose is the only thing that can unite them.

In the film, and a companion book, The Nun and the Bureaucrat--How They Found an Unlikely Cure for America's Sick Hospitals, Crawford-Mason and co-author Lou Savary examine how Deming's principles were used in a group of Pittsburgh Hospitals. The nun in the book's title is Sister Mary Jean Ryan, CEO of SSM Health Care system. In 1989 she teamed with Former Treasury Secretary Paul O'Neill, who raised safety and profits dramatically at Alcoa, when he was that company's CEO, using Toyota automobile manufacturing methods that were guided by Deming. The hospitals have reduced waste and cost by almost 50 percent, eliminated hospital-acquired infections and reduced medication and medical errors and more.

So why isn't the health care debate focusing on solid ideas that actually work? Crawford-Mason says:

Effective management ideas don't fit in 15-second sound bites or on bumper stickers. Perhaps our leaders and candidates have too short attention spans to propose and debate complex solutions or are worried about boring the voters.

There isn't much drama in fixing management systems and increasing quality as doctors and nurses go about their daily business. There's no vanished Eden to bemoan, no city on a hill we have abandoned, no ideal America to get back to in the nitty-gritty details of fixing health care.

There's another old American tradition that collides with the Eden Myth. It's Yankee Ingenuity, the notion that we Americans can use our brains and our hands to sculpt solutions to intractable problems. W Edwards Deming, who died in 1993, came from that tradition.

"Americans like quick fixes and are suspicious of solutions 'not invented here,'" says Crawford-Mason, "so it's important to note that the man who developed the theory to better manage modern organizations began to devise his ideas as a young man on the Wyoming frontier in the early 20th century. Deming understood that Western towns prospered from barn raisings, quilting bees and other cooperative efforts, not lone rugged individualists."

It's that cooperative, common sense ingenuity that we need to get back to. The only map to Eden lies in our will and our brainpower.