Friday, March 7, 2014

Ten General Propositions about Health Reform

I dare say I have worked off my fundamental proposition that the chief end of many of us is to frame general propositions and no general proposition is worth a damn.

Oliver Wendell Holmes, Jr, (1841-1935)

One,  the poor and  uninsured will always be with us, no matter how noble your intent or intent your desire to alter the situation: few are signing up for the law and by a ratio of 2:1, they oppose it.

Two,  to satisfy most of the people most  of the time and to stay in office, you have to keep changing the rules to satisfy more of the people more of the time.

Three, to cover most of the people most of the time,  you have to use Other People’s Money – the Have’s, the Young, and the Healthy – and most of this money will come from the Middle Class, not from the Rich.

Four,   to cover  most of the people most of the time requires a healthy growing economy: that economy requires your  embracing an economic system you may not believe in.
Six,  to afford people with  equal opportunities is not the same as guaranteeing equal outcomes: to try to equalize the two is to try to reverse the law of human nature, which is that some people are more equal than others and have skills that others do not have..

Seven,  to achieve successful reform you must grasp the reality that  many people prefer personal one-on-one care from a physician to team-care from an institution or from government.

Eight,  to  judge or to assure the “quality” of medicine, or the satisfaction of care derived or delivered thereof,   by clinical algorithms or data outcomes alone is a fool’s errand.

Nine,  to think of  the computer as the only effective tool  for connecting with people is foolish and simplistic; the computer is not effective for communicating with people, for many of the people you want to reach are not computer-savvy nor do they care to be.

Ten,  to achieve effective  reform,   you must recognize  that   individualism and humanism  are  not always compatible with collectivism and elitism.

Tweet:   General propositions about how to achieve health reform may not be worth the 2700 pages the health law is  written upon.

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