Wednesday, May 4, 2011

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.


BobbyG said...

"The discoveries of healing science must be the inheritance of all. That is clear. Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the same way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion. Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available."

- Winston Churchill, 1944

Richard L. Reece, MD said...

“They say that nobody is perfect. Then they tell you practice makes perfect. I wish they'd make up their minds.”

Winston Churchill

HaynesBE said...

Dr. Reece--Nice summary!

John Dick said...

The statists and socialists, and all their utopian programs and policies, such as a national health care system, have had many years --- say around 100 years now --- to try to perfect their progressive, collectivist ideals, with millions of human lives wiped out worldwide paying the price of the Marxists trying to achieve "practice makes perfect."

But one cannot perfect that which starts from flawed premises --- except that maybe statism and socialism, including their collectivist programs and policies, always lead to perfect societal chaos and tyranny every time. This at least can be counted on for sure.

We must learn that it is futile to try to negotiate with that which is not legitimate in the first place. Fundamentally, statism and socialism are not legitimate social systems for any proper civilized free society --- they are the social systems of slaves and masters, of thugs and murderers. There is nothing for a free man to gain --- but only everything to lose --- by trying to negotiate with those who think his life belongs to the state, that his individual rights and property rights mean nothing, and that his only role in life is to be controlled, forced and used as fodder for the collective good.

There is nothing for free men to gain, and everything to lose including life, by being forced into slavery and servitude through such socialist doctrines and programs as nationalized health care systems. In the end, it is only true, total individual and economic freedom for all individuals (and, yes, this includes patients, doctors, and businessmen) that will solve any of our social concerns.

james gaulte said...

Thank you for you insightful analysis of the attitudes of the advocates of the "health reformers".From time to time I blog about that and offer this summary statement of the view of the reformers; "Medicine is too important to be left to the individual physician and the individual patient."

Anonymous said...

Partial re-posting with a link back to the same ideas because they are helping you fleshlight grow.

God's outstretched translucent veiled hand also represents the traditional roof sechach of the sukka above Moses' head.