Why we can't have an honest debate about healthcare
The answer to this question is so fundamentally obvious that it amazes me all the brilliant people out there working on this have still failed to answer it. We can't have a debate because no one understands it well enough. Listen to Obama, or your favorite Congressman or Senator speak on the issue. They babble, bouncing for soundbite to soundbite without actually saying anything substantive. Numbers? huh? Statistics? what? Actual facts? you mean, you actually wanted those? This is the sort of ad lib filler that I usually see on 24/7 news channels on a slow news day. You know, the days when they start talking about the Sri Lankan baby born with 7 toes and an elephant's trunk or when they start reading off of Twitter like it's a legitimate source of information to report. That kind of garbage. I'm frankly tired of it.
So here's problem #1: There's only one option on the table.
If you have only one option on the table, the discussion quickly reduces down to 'take it or leave it.' Given the average person's inherent psychological need for routine and resistance to large changes, Obama's plan has hit like a sucker punch and the gut reaction to it is to push back from the table and leave.
People appreciate simplicity. Our government produces most of its documents and publications intended for the masses written at a third grade reading level. Even our under-educated, grade-inflated, ego-stroked, cracked out high school drop outs need to be able to understand what they're getting and navigate it, so the government simplifies things to a picture book level. When Congress put together a 1000 page desk ornament and stamped it 'Obamacare,' people took one look at it, saw it wasn't a Harry Potter book extended their middle-fingers, and went back to playing solitaire on their computers at work. Even intelligent people knew that they didn't want to read the thing, even if Congress had titled it 'The Great American Novel on Healthcare'.
Now, there are a lot of talking points out there, so obviously some poor bastard had to sit and attempt to wade through the legal labyrinth found between pages 1 and 1000. We hear people say everyone is going to get healthcare (Great!). We hear it's going to cost money (Not so great). We hear the rich are going to pay for it (Great, unless you're rich). Then we hear that there aren't enough doctors (Oops?), the costs were underestimated (Oops again?), and that the government is going to tell poor Grandpa he can't have a quintuple bypass next time he has a heart attack and will be sent to hospice care (I smell politics!). So, clearly, there are a lot of promises being made about a perfect system (no such thing) and a lot of people who haven't read the bill telling other people who haven't read the bill that it's not going to work. At this point, we're too busy arguing over what He said and what She didn't say to actually see that we're not debating anything.
So, the situation here is that we have a 1000-page paperweight no one wants to read on one hand, and a system that's already in place and for the most part, managing to take care of Aunt Sally when she's sick. Most of what we hear about the plan is bullcrap, so no one listens. People are choosing the status quo because for whatever reason, they haven't been convinced that reform is going to be a positive change.
Problem #2: Doctors are collectively awful publicists
There are good alternative suggestions out there. I've read them. Some in the New England Journal of Medicine. Some in the Journal of the American Medical Association. Some in the Wall Street Journal, and one very interesting idea from the opinions page of the Washington Post. So why aren't we hearing about them? Doctors who have the experience and time to treat patients don't have the time to do interviews, lobby Congress, or pose in Playboy (or Playgirl?) to get the attention necessary to present their thoughts on a national stage. There are academic doctors at major teaching hospitals and medical centers all over the country suggesting alternatives, or at least thinking through the potential ramifications of Obamacare, but they publish their thoughts where only other doctors will ever see them and in language only another Ivory Tower champs can read.
And while doctors are too busy to communicate properly, all we're hearing at the public level is the White House's and the GOP's talking points. And trust me, I'm not taking advice on how to make 1/7th of the country's economy financially solvent from a bunch of guys who send their kids to private schools, can't balance the budget, and think nothing of spending millions of dollars every four years trying to get a job that pays $200 grand. And neither is anyone else. So what happens is that 'debate' continues without any real facts or good ideas being considered because so few people who actually need to hear them in fact are hearing them.
Problem #3: Healthcare is boring
It's true. As much as we all know we need it, we don't want to deal with the specifics. Just like when you buy a computer, most people don't really care what the front-side bus is or whether you have 184 or 200 pins on your RAM chips. When we buy healthcare, we don't really care about the specifics. We pay a doctor so they can worry about that. So when we're listening for suggestions and 60% of them involve details that read like a drug formulary or a new insurance policy, we switch over to Desperate Housewives or 30 Rock. Obama, for all his charisma and charm has failed to be able to parlay that into a vibrant discussion on healthcare in this country. Change is an easy message to sell to a country that hates the course it's ship of state has taken. It's not so easy to sell when people aren't convinced they need to pay more attention to healthcare than they do to which new starlet is flashing her unmentionables.
Problem #4: We're asking the wrong people
When we consider the problem of healthcare reform, the people we hear talking are politicians. These are the same people who outsource their research, outsource their media releases, and in general don't do much but take other people's work and present it as their own. Don't believe me? Check out how Congressional Subcommittee's work. Your Congressman/Senator is a manager with a megaphone. They know squat about medicine.
So, let's ask the doctors, right? Well, kind of. Just like your Congressman is managing his army of researchers, your doctor is managing an army of nurses and technicians who are providing the care they order. Doctors aren't thinking about cost efficiency very often, unless it's with regards to their bottom line. If you want to get good feedback, you need to talk to the nurses and technicians who are ordering supplies, handling the technology, maintaining the hospitals, and see where they can cut costs. Doctors are going to tell you a very simple answer when asked about cost: "I don't care how much it costs, because a human life is more valuable." That's exactly what I expect of my doctor. If my leg is broken and I need it fixed, I want them thinking about how to fix it, not how much it costs to keep a C-arm running so they can get additional views while they work. When doctors think about cost, they think about how much they have to try and talk insurance companies out of in order to cover their overhead.
So, that said, we need to have more suggestions on the table. We need to have a nationwide brainstorming session where everyone who works in healthcare from the orderly to the CEO of Kaiser Permanente throws out suggestions. We need to consider what is working well, so we don't screw it up by making changes that aren't necessary, but most of all, we need to have moderation at the level of the national media to filter the mudslinging. If the media can't be intellectually honest in it's reporting, we'll be forced to take the mangled, dog-chewed remains of post-Congress Obamacare whether it's any good or not.
So here's problem #1: There's only one option on the table.
If you have only one option on the table, the discussion quickly reduces down to 'take it or leave it.' Given the average person's inherent psychological need for routine and resistance to large changes, Obama's plan has hit like a sucker punch and the gut reaction to it is to push back from the table and leave.
People appreciate simplicity. Our government produces most of its documents and publications intended for the masses written at a third grade reading level. Even our under-educated, grade-inflated, ego-stroked, cracked out high school drop outs need to be able to understand what they're getting and navigate it, so the government simplifies things to a picture book level. When Congress put together a 1000 page desk ornament and stamped it 'Obamacare,' people took one look at it, saw it wasn't a Harry Potter book extended their middle-fingers, and went back to playing solitaire on their computers at work. Even intelligent people knew that they didn't want to read the thing, even if Congress had titled it 'The Great American Novel on Healthcare'.
Now, there are a lot of talking points out there, so obviously some poor bastard had to sit and attempt to wade through the legal labyrinth found between pages 1 and 1000. We hear people say everyone is going to get healthcare (Great!). We hear it's going to cost money (Not so great). We hear the rich are going to pay for it (Great, unless you're rich). Then we hear that there aren't enough doctors (Oops?), the costs were underestimated (Oops again?), and that the government is going to tell poor Grandpa he can't have a quintuple bypass next time he has a heart attack and will be sent to hospice care (I smell politics!). So, clearly, there are a lot of promises being made about a perfect system (no such thing) and a lot of people who haven't read the bill telling other people who haven't read the bill that it's not going to work. At this point, we're too busy arguing over what He said and what She didn't say to actually see that we're not debating anything.
So, the situation here is that we have a 1000-page paperweight no one wants to read on one hand, and a system that's already in place and for the most part, managing to take care of Aunt Sally when she's sick. Most of what we hear about the plan is bullcrap, so no one listens. People are choosing the status quo because for whatever reason, they haven't been convinced that reform is going to be a positive change.
Problem #2: Doctors are collectively awful publicists
There are good alternative suggestions out there. I've read them. Some in the New England Journal of Medicine. Some in the Journal of the American Medical Association. Some in the Wall Street Journal, and one very interesting idea from the opinions page of the Washington Post. So why aren't we hearing about them? Doctors who have the experience and time to treat patients don't have the time to do interviews, lobby Congress, or pose in Playboy (or Playgirl?) to get the attention necessary to present their thoughts on a national stage. There are academic doctors at major teaching hospitals and medical centers all over the country suggesting alternatives, or at least thinking through the potential ramifications of Obamacare, but they publish their thoughts where only other doctors will ever see them and in language only another Ivory Tower champs can read.
And while doctors are too busy to communicate properly, all we're hearing at the public level is the White House's and the GOP's talking points. And trust me, I'm not taking advice on how to make 1/7th of the country's economy financially solvent from a bunch of guys who send their kids to private schools, can't balance the budget, and think nothing of spending millions of dollars every four years trying to get a job that pays $200 grand. And neither is anyone else. So what happens is that 'debate' continues without any real facts or good ideas being considered because so few people who actually need to hear them in fact are hearing them.
Problem #3: Healthcare is boring
It's true. As much as we all know we need it, we don't want to deal with the specifics. Just like when you buy a computer, most people don't really care what the front-side bus is or whether you have 184 or 200 pins on your RAM chips. When we buy healthcare, we don't really care about the specifics. We pay a doctor so they can worry about that. So when we're listening for suggestions and 60% of them involve details that read like a drug formulary or a new insurance policy, we switch over to Desperate Housewives or 30 Rock. Obama, for all his charisma and charm has failed to be able to parlay that into a vibrant discussion on healthcare in this country. Change is an easy message to sell to a country that hates the course it's ship of state has taken. It's not so easy to sell when people aren't convinced they need to pay more attention to healthcare than they do to which new starlet is flashing her unmentionables.
Problem #4: We're asking the wrong people
When we consider the problem of healthcare reform, the people we hear talking are politicians. These are the same people who outsource their research, outsource their media releases, and in general don't do much but take other people's work and present it as their own. Don't believe me? Check out how Congressional Subcommittee's work. Your Congressman/Senator is a manager with a megaphone. They know squat about medicine.
So, let's ask the doctors, right? Well, kind of. Just like your Congressman is managing his army of researchers, your doctor is managing an army of nurses and technicians who are providing the care they order. Doctors aren't thinking about cost efficiency very often, unless it's with regards to their bottom line. If you want to get good feedback, you need to talk to the nurses and technicians who are ordering supplies, handling the technology, maintaining the hospitals, and see where they can cut costs. Doctors are going to tell you a very simple answer when asked about cost: "I don't care how much it costs, because a human life is more valuable." That's exactly what I expect of my doctor. If my leg is broken and I need it fixed, I want them thinking about how to fix it, not how much it costs to keep a C-arm running so they can get additional views while they work. When doctors think about cost, they think about how much they have to try and talk insurance companies out of in order to cover their overhead.
So, that said, we need to have more suggestions on the table. We need to have a nationwide brainstorming session where everyone who works in healthcare from the orderly to the CEO of Kaiser Permanente throws out suggestions. We need to consider what is working well, so we don't screw it up by making changes that aren't necessary, but most of all, we need to have moderation at the level of the national media to filter the mudslinging. If the media can't be intellectually honest in it's reporting, we'll be forced to take the mangled, dog-chewed remains of post-Congress Obamacare whether it's any good or not.
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