Culture, effect of -Understanding U.S. Health Care

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This series of blogs is intended as a sequel to Innovation-Driven Health Care. Indeed some of these blogs may serve as the core of a new book.

I described Innovation-Driven Care as follows:

This book does not defend U.S. health care. It explains it. It is pragmatic, not phlegmatic. It preaches action, not reaction. It is more about technology than ideology. It espouses energy – and synergy. It speaks of pro-innovation need, rather than preaching any anti-government screed. It is more contextual than intellectual. It seeks clarity, verity, and parity between market and government sectors, rather ideological purity. It is about restructuring the health care infrastructure. It is about how the here and now may lead to the then and there.

Similarly these blogs are about understanding, not grandstanding about the need for transforming the U.S. health. They are about comprehending, not reprehending our health system. Basically understanding our health system and directions it is headed boils down to understanding our culure.

Since out founding 230 years ago, our culture has been characterized by:

1) A distrust of centralized federal power. That’s why our Constitution preaches checks and balances between the executive, legistlative, and judicial branches. That’s why Americans distrust sweeping federal control over health care. That’s why health care changes are incremental rather than fundamental.

2) The desire for choice. Americans want choices of health care institutions and providers. Choices honor individualism and freedom, and that’s what America is about. That's why the consumer-driven health care movement may be powerful. That's why th engaged, sometimes enraged, patient will make a difference.

3) Equality of opportunity not results. America is known as the land of opportunity, where everybody has an equal opportunity to excel and prosper. This is not the same as a egalitarian equitable society, where the haves are heavily taxed to support the have-nots. America is not Nirvana – or Havana.

4) Access to technology. Americans believe in investing in medical research and high health care technologies – and in having quick and sure access to those technologies. That’s why they abhor long waiting lines or rationing to restrict that access.

5) A capitalistic market-based society. America is a capitalistic society. It embraces market-based solutions – with all their benefits, faults, warts, and blemishes. This does not mean capitalism is perfect. Capitalism deserves only Two Cheers. That’s why innovation is always needed to make it better.

These American cultural traits explain why Americans prefer local and regional solutions, why they have rejected mandatory government health coverage for nearly 100 years, why they feel capable of making their own health care decisions. why the seek equal opportunity access of high technologies, why they prefer pluralistic payment systems, why they allow market-based and public-based institutions to co-exist and compete, and why they permit doctors to behave democratically, seeking their own locales to practice, often acting independently of hospitals, health plans, and govenment, and making their own decisions and clinical judgments, free of the fetters of outsiders; and why, in the end, smart, informed health care consumers and patients will fundamentally change the health system for the better.