Change the System, Stupid (Part 3 of 3)

After reading the preceding two parts of this trilogy, we understand that we must treat causes not symptoms (Part 1) and that it is the system, not people or parts that must be changed (Part 2). In this third, final article, we answer the question: What can and should we do?

One of the most common excuses people use is: They will never let me do it [even when people do not know what "it" is]. The all-powerful, never-named "they" loosely refers to people with big salaries and fancy titles, generally with elected or appointed high office, in other words, "they" are people with the power of position. In the USA, the real power rests with the people - you and me. As long as that power rests quiescent, as long as we do not use it, then we get what "they" decide. Time to change that.

CHANGE, OR MORE-OF-THE-SAME

The first step is, as they say, always the hardest. It must happen in our minds. We need to Stop 3, and Start 3.

STOP 3

• Stop blaming: it serves as an excuse to avoid own responsibility to act and worse, blaming cures nothing.

• Stop confusing symptoms for causes and the meanings of words. To cure anything, we must treat causes not just symptoms. To avoid communication errors by being clear and in agreement on the meanings and implications of words like cost and market-driven.

• Stop expecting (and waiting for) a silver bullet or magic potion. The Lone Ranger and Harry Potter may have them, but in our world, simple, quick, easy effective answers to big, complex problems do not exist.

START 3

• Start believing. Healthcare is fixable. We can have both cheaper and better. The person who can and must cure healthcare is you (and me and everyone else).

• Start creating a consensus. We need general agreement - a consensus - on what is truly wrong with healthcare and what we want any new system to do.

• Start demanding leadership for change, but not just any change. We want a new system that will produce the outcomes we want, built along guidelines we establish.

CHANGE THE SYSTEM. (REPLACE IT.)

If a system is broken, you fix it. If it - our current medical malprocess - cannot be fixed,, then we must replace it with a new process, one that works. Adjustments in healthcare financing viz., universal health insurance; tweaking the medical malpractice system, viz., caps on awards; or big bold resolutions like the Patient's Bill of Rights: these will not cure healthcare. We can do without the rousing slogans and great sound bytes. We do not need more grandiose but ultimately ineffectice promises. We need an medical process that: maintains and when necessary restores our good health; helps us when we are injured; and keeps learning continuously so that the care we receive can keep getting better.

DEMAND LEADERSHIP FOR CHANGE

Creating a new healthcare system will require the power of the People. We have to be willing to accept change both in our system and in our selves. To start this process, we need to break through the logjam created by partisanship and election cycles, and circumvent the influence of the special interests. We need to achieve a consensus on what is wrong and on what we want. To do all this requires a national dialogue on healthcare: us talking to us. We certainly want to include medical leaders and practitioners, managers, legislators, economists, experts of all sorts, but ultimately we must decide.

We require the government to begin a process of general education and discussion: talk shows; town hall meetings; televised debates; pro & con articles in newspapers and magazines: all focused on what is really wrong with healthcare (the causes) and what we want any system to accomplish. At the end of a two-year dialogue, there will be a referendum on healthcare with our entire populace voting on ten key questions. Our answers will create guidelines for the creation of a new, effective medical (bene, no longer mal) process, to be implemented no later than four years after the referendum.

We can learn from various sources: business experience; management expertise; successes and failures in healthcare in other countries. What we cannot do is take any single answer, technique or even philosophy, impose it unmodified on our system and expect nirvana. The only answer that will work for us is one that we create.

Learning from our experience in healthcare, the Public should make a second, even more basic demand of our legislators, regulators, and those with authority over large numbers of people: all decision-makers must have evidence (proof of effect) before making a decision that affects us all, as well as feedback of consequences (with teeth) to those who make these decisions. When you personally waste money, you suffer the consequences. When our Representatives waste millions on a bridge to nowhere or billions on HIPAA, there seems to be no consequence to them (just on us who have to pay the bills). All decision-making should have evidence and feedback.

Note: Every statement made herein can be supported by evidence: they are not simply author bias. For examination of references, feel free to contact the author.