The U.S. health system, effect of culture - The Health System, From Top-Down to Bottom-Up, As Seen Through the Lens of Cultural Complexity

This blog’s title is the sub-title of my book Obama, Doctors, and Health Reform.

What do I mean by this subtitle? Good question. As I told a friend of mine once “Don’t tell me something is too complex to understand. Try me.”
OK, I’ll try to convince you and myself.

First, reform entails turning downside up a health system in a bottom-up society in a vast continental nation with strikingly different regional cultures. For examples, I now live in Connecticut, where the average sized physician group is about 5, but I lived in Minnesota where the typical physician group is 150 doctors; Kaiser flourishes in California, but it has failed in Connecticut and Texas: near universal coverage may work in affluent Massachusetts, where it has raised costs by 32% in three years, but it’s not likely to work in California, which has a budget deficit of $24 billion.

Second, for 233 years, America, to escape from European top-heavy governments, has been a culture that distrusts government and worships individualism. It believes all men are created equal, But it does not believe all men must be kept equal. It believes in equal opportunity. But it does not necessarily endorse equal results. Polls indicate most Americans who do not want health insurance should be forced to buy it.

Third, Americans believe in freedom of choice, in deciding what health plans and doctors they want to choose, and in capitalism rather than socialism. These mindsets complicate the politics of imposing a predominately government run system and creating a public health system to compete with private plans.

Four, it is hard to superimpose a government controlled, regulated system, and health care provided care system on the current deeply ingrained system based on employer provided care with care delivered by private organizations and private physicians. Here an analogy with General Motors, which has just declared bankruptcy, may be order. Medicare, after all, is just 6 years away from a bankruptcy of its own. As a GM executive, Elmer Johnson, noted in a January 11, 1998memo, “We have vastly underestimated how deeply ingrained are the organizational and cultural rigidities that hamper our ability to executives.

Five, the health care sector is perhaps the only U.S sector gaining in employment and in positive economic impacts in many communities. Indeed, health care dominates the economy and is the largest employer in countless towns, cities, and regions. In New York City, representative Charles Rangel, who has spent his entire career protecting New York City hospitals, stoutly refuses legislation that would tax the health benefits of corporations and that would presumably decrease patient traffic to New York City hospitals.

Six, I have never met a health care leader – of a hospital, drug company, device manufacturer, health plan, academic medical center, or physician group – whose declared mission was to decrease the market share or profit of his/her organization, cut the income of employee, to lay off employees to save money for patients and to make care more “affordable.” That is simply not in the cards for a capitalistic society, for competing in a technology-driven health system engaged in marketing wars with competitors, for offering superior quality care, or for complying with government regulations. As the saying goes, “no margin, no mission.”
As David Brooks metioned in his June 2 column in the New York Times, “The Quagmire Ahead, “ government control does not assure success. It merely assures endless bailouts and printing money to cover deficits. “An overconfident government throws itself into a dysfunctional culture it doesn’t understand. The result is quagmire. The costs escalate . There is no exit strategy.”

Or, a John Goodman, founder of the National Center for Policy Analysis, a conservative think-tanksaid in a speech “A Prescription for American Health Care before the Hillsdale College National Leadership Seminar, “Liberating the medical market by freeing doctors and patients is the only way to bring health care costs under control without sacrificing quality. Continuing on our present path – allowing health care costs to rise at twice the rate of increase of the rate of income under the aegis of an unworkable government Ponzi scheme – is by comparison unreasonable.”

As I said in the beginning, health care reform is too complex for most of us to understand on both sides of the political aisle in our left-drifting market-driven capitalistic culture.

Some liberals are becoming conservatives mugged by the Obama-estimates of $1.3 trillion required to achieve universal coverage over the next ten years.

And some conservatives are becoming liberal as they contemplate what current health costs are doing to hamper their abilities to compete in the global marketplace.