Dr. Kelly Rainer teaches at Auburn University, and he recently posed this question to his masters level students in an MIS class. He’s an excellent teacher and his classes are extremely engaging. He encouraged conversation on the right v. privilege question by assuring the students that there is no right answer to the question, freeing them up to speak their minds. I don’t think Dr. Rainer really believes there is no right answer, and I don’t, either. Most questions have one, when examined through the lens of a quality geek.
A true quality geek would tell you that well-designed systems do their best to prevent defects from occurring. So try to look at the health care question from the perspective of cost/benefit and health of the system. Putting aside for the moment whether it’s fair or not that money is a barrier to health (though I have strong thoughts on the issue, it’s an opinion question that’s hard to talk about factually), we can say definitively that the current system in the US is driving a reactive medical culture. US doctors and hospitals, etc. are fantastic at fixing us when we’re broken (reacting to defects), but crap at preventing us from becoming broken (preventing defects from emerging).
If you can imagine a system that can be described like this at an organizational level, anybody with any sense would say that it’s poorly designed (insofar that any system that values reaction over prevention is inefficient by definition). Any system that can be accurately described in these terms is producing the wrong answers as a matter of design. So to defend this kind of system doesn’t make any logical sense.
The primary drivers of the healthcare system in the US are all financial. So the primary outputs that make any sense are also financial. The financial stakeholders – doctors, insurance companies, big pharma – are all doing quite well, because the system is designed to ensure that they do quite well. The patient’s experience, on the other hand, has a large degree of variation because it is directly correlated with access to funds. So the system isn’t designed to ensure consistently positive outcomes for all types of patients.
“So what?”, I guess is the right cold analytical question. Well, one result of a system that is designed to be reactive is constantly climbing costs. This is true of any reactive system. So the ’so what?’ is that the system, as it’s designed, is unsustainable. It’s a system that’s bringing corporations as large as Ford, Chrysler, and GM to their knees at the moment – and they’re just the canaries in the coal mines. Every corporation that provides health benefits will have to address this issue relatively soon.
It’s true that it’s a huge problem that’s scary as hell to actually deal with. But not dealing with it because it’s a huge and scary problem is without question the wrong answer.
