Thursday, October 24, 2013

And Who Shall Say What Is Best Health Care for the People?
Government may think it knoweth,
What is best for most of us.
But the market often bestoweth
What is good for the rest of us.

That is what I said in the foreword to my  book The Health Reform Maze (Greenbranch Publishing,  2011).
In light of the continuing problems with the government’s health reform law,  including its website,, now is a good time revisit the question of  who and what is best for the American people’s health?
Is it  government?   At an ideological level,  the best health care for all  was what was intended with the Patient Protection and Affordable Care Act.  But at the more practical level of the market, considering and other snafus,  the question becomes: is the government capable and competent enough to carry out of the massive task of regulating care for 310 million Americans spread across a vast continental nation?
Is it markets?  Is it capable of providing equitable  for all Americans?   Not in the eyes of progressives.   An efficient market may raise all boats, as President Kennedy said,  but as Winston Churchill noted,  capitalism’s inherent vice is the unequal sharing of blessings, while socialism’s virtue is the equal sharing of  economic miseries.
Is it the medical profession?   Certainly the profession knows more about diseases – their prevention and their cure - than government and markets.    But  physicians,   being rational human beings,  tend to protect and advance themselves  ecoomically by charging enough to pay off the $300,000 worth of debts accumulated during their education years and time lost before entering the market place.
Is it the people themselves?    They know what they want -  good health,  a long life, and  compassionate doctors who treat them with the latest and best medicine available no matter what the price.    But,  because of the U.S. third party system, patients and health consumers are insensitive to price,  and because of their inability to compare prices and outcomes, they do not have the tools to make rational economic decisions and the system runs out of other people;s money.
Is it health care organizational  leaders  in health plans, hospitals,  and  large integrated health groups?   They have access to data on health outcomes, to the best in medical science,  and to what works and doesn’t work for large populations  with specific diseases.   They know the truth of the truism, an ounce of  prevention is worth a pound of cure.  They have the managerial and marketing skills and health care to reach and teach millions, but they also have special interests - making enough profit to stay in business and grow. 
Is it creators of information technologies?  Can the Internet,  the social media, the mobile devices save  - in the hands of government officials and the market IT leaders – make the system more efficient and affordable?    The current debacle, which may be temporary,  gives us pause about this solution.   And what is provided  over the Net is a mixed bag of  the good and bad information.  Remember:  behind every computer program is a human being.
Who is to say what sort of  health system is best for the American people?   In the end,  it will be the wisdom of the people themselves, after seeing what the ObamaCare delivers, who will decide. .
Tweet:  What shall decide what’s the best health system – government, markets, doctors, organizations, IT technologies or the wisdom of the people?

Source:  James Surowieki,  The Wisdom of Crowds: Why Many Are Smarter Than the Few and How Collective Wisdom Shapes Business, Economics, Societies, and Nations (2004).

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