Health Reform: The Altitude Affects the Attitude

Attitude is a little thing that makes a big difference.

Winston Churchill

If I were to identify two things that turns physicians off about health reform, it would be the altitude, and a set of attitudes.

This altitude and set of attitudes include.

• Big Brother, government and managerial experts, know best.

• These experts, political and social theorists and analysts, know more than individuals at the point of care.

• A centralized health system reflects collectivist compassion, not repression of individual freedoms and choice.

• Statistics on average population behavior are more important than individual heuristics.

• You cannot trust doctors - their training, their experience, their intuition, their motives.

• You cannot trust patients - their knowledge, their instincts, their choices, their decisions on how to spend their own money.

. You cannot trust markets, which express citizen behavior at street level.

• You can trust data, "In God we trust, all others bring data” as the managerial mantra goes.

• Information – truckloads, wheelbarrows, computer drives, and databases full – will solve all problems, empower all people, improve all outcomes.

• Artificial intelligence is the Holy Grail and will ultimately support, supplement, and even supplant human intelligence.

• Physicians do not have the interests of their patients in mind, they only have their personal interests in mind.

• Physicians, hospitals, and other caregivers, not patients. are responsible for most bad disease outcomes.

• Wisdom on health care matters resides at the top of the pyramid, where power is concentrated, rather than at the bottom of the pyramid, where care is created.

• If we make care free to all, impose enough rules to regulate care, and build a big enough bureaucracy, costs and demand will go down, when in truth, the opposite holds true.

• If we lower physician and hospital rates, discourage specialists and encourage generalists through payment reform, coordinate and concentrate care in large organizations, manage, prioritize, and systematize the behavior of all concerned, and transform the culture from individualism to collectivism, all will be well, the physician shortage will ease, and physicians and the public at large will come to their collective senses and reach consensus that what's good for all is good for each.

Attitude is an intangible, You cannot weigh it, or otherwise quantify it. But you can examine it, sense it, feel its consequences, and acknowledge its impact, for better or worse.