And Who Shall Organize Health Care?

In 1988 I wrote a book And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota.

My answer was that in the future health care corporations, or managed care corporations, and doctors working for these organizations, would be caring for the sick.

The only way doctors could exert their independence, I said, would be to form organizations of their own. Medicine had become a big business, and only organizations with access to capital, the skills to deal with management and bureaucratic issues, the scale to market to populations, and the ability to mobilize technologies and specialists to address issues of disease prevention, wellness, the ills of an aging population, and organized and led by managers and executives for perpetuity would survive.
But who shall organize these organizations? Who should take the vows of organization fealty, to be loyal to the organization in perpetuity above all else – even if one has to sacrifice individual freedoms of doctors and patients.

Shall it be government? As a social organizer dedicated to equalizing benefits and access to health care for all, President Obama thinks the role of organizing health care belongs to government.

Shall it be managed care organizations, working in concert with government and carrying out the mission and programs of government? These organizations have capital and organizational skills to do the job.
Shall it be hospitals acting as integrated health organizations, dominating their community and regional markets, employing physicians; setting up diagnostic, treatment, surgery centers, rehab, and emergency facilities; owning hospitals, even insurance companies? It’s beginning to look like that’s the way it’s going to go.

Shall it be physicians themselves? Not likely. They do not have the management skills or the capital, and their traditions of autonomy, independence, and professional rivalry make the formation and maintenance of large organizations difficult.

Shall it be consumers, patients, and voters? It’s a possibility. Consumer-driven care has been the mantra for a decade now. We are a consumer-drive society. And by exercising choice on a massive scale, consumers could certainly tilt the scales towards organizations of their choice.

Or shall it be information technologists, those soft-ware wizards, those digital networking genies and and gurus, who, over the last 10 to 20 years, have remade American society by making it possible for everybody with access to computers and the Internet to connect with each other, with the population at large, with health care organizations, to help all gain health care information, and theoretically to judge what health care providers are good or bad, and what is good or bad for their health?

I would not discount the latter as the clue and the glue to the future. I have been reading a book The Wikipedia Revolution: How a Bunch of Nobodies Created the World’s Greatest Encyclopedia (Hyperion, 2009). The book describes how thousands of idealistic software nerds, acting voluntarily, usually without pay, have made it possible for every single person to have free access to the sum of all human knowledge. Every person can freely edit Wikipedia. Its founders say Wikipedia has five pillars that have made it the rival of Google, Microsoft, and Facebook in terms of online traffic. These five principles are: 1. Wikipedia is an encyclopedia. 2. Wikipedia has a neutral point of view. 3. Wikipedia is free content. 4. Wikipedia has a code of contact, and 5. Wikipedia does not have firm rules.

Wikipedia is community-based. It reflects community-oriented interactions. It is relatively free of partisanship,, and pessimistic nay-saying. It assumes the hundreds of thousands of software nerds, editors, and contributors who work on Wikipedia are trying to help it, not hurt it; and it avoids accusing others of harmful motives.

Above all, Wikipedia is neutral. And it believes any problem can be fixed through collaboration, consensus, and bold actions to get things right. All contributions must be factual, reliable, and verifiable.