What is Health Reform All About?

September 18, 2011 - Last night I dreamt I had the answer to this question: What is health reform all about?

My answer? It’s systematists versus individualists.

A systematist is someone who develops, follows, or conforms to a system ; an individualist is someone who thinks or behaves individually.

Systematist Beliefs

A systematist believes in central planning, in guiding, expanding or narrowing options to achieve a goal, in reducing myriads of data to digestible bytes or swallowable whole.

A systematist believes in numbers, in using them to develop processes for continuous improvement to achieve six sigma with zero defects.

A systematist believes in protocols and checklists to guide people to a desirable and achievable goals.

A systematist believes data in hand, prior to or at the site of an action, is worth two in bush, i.e., viewed retrospectively.

A systematist believes the ideal tool for assuring conformity to system goals is the computer – a logical, impersonal, objective, programmable machine devoid of human emotions.

Individualist Beliefs

An individualist believes in freedom and flexibility ,of shaping individual actions at the point of a human transaction based on the situation, circumstances, and desires of the individuals involved in the transaction.

The individualist believe forcing conformity to a system is the road to serfdom, to being a servant of outside authorities.

Ironically, the individualist believes the computer, and its thousands of applications – embedded in Twitter, Facebook, YouTube, mobile apps on Ipad, Ipod, and Iphone, or any other mobile device– are the road to individual freedom, to connecting with other individuals , to bypassing the system.

The individualist believes you can use online tools to get your own information, ideas, products – to rate what’s available to you , to cut your own deals, write your own news, promote yourself.

The individualist believes you can use online technologies to get the things you need rather than going through traditional channels.

Homogenization Versus Humanism

In my dream, the issues between system and individual believers boiled down to homogenization versus humanism.

But when I awoke, I knew reconciling these views was not that simple.

Organized, purposeful, systematic approaches can improve health results for populations of people and for individuals. On the other hand, systems can handicap individualism, hamper innovation, invade privacy, enforce compliance, and limit freedom of action.

Maybe systems are the price we must pay for living in a civilized society. Conversely, maybe individualism is what makes life worth living, creativity worth pursuing, and practice worth practicing.

In human society, it’s always six of one and half dozen of the other. In health reform, on the national scene, it may come down to this: give me systems of care, give me individual freedom of action, or give me consequences - inequities, uneven quality, debt, or excellence engendered by competition and choice.

Tweet: In the real world of health reform, it's still the same old story - systematic approaches to improve care versus individual freedoms.