Organizations and Size Matters

In my 45 years of writing about health reform, I have learned organizations and their size matters. As I wrote in my 1988 book, And Who Shall Care for the Sick? The Corporate Transformation of Medicine, “Let’s concede that this is the age of management in which major social tasks – from education, to economic services, to health care – are entrusted to large organizations, let’s not say: “Down with health care organizations!” Let’s study management techniques and methods, and let’s apply them to our own situation in a responsible way that increases our leverage, maximizes our effectiveness, and brings medical knowledge to society in the most efficient ways…The biggest danger of corporations is that they are treating health care as a commodity…a product to be controlled, priced, limited, and parceled out. People do not like to be thought of as a product, or piece of meat, moving through an assembly line. It is up to us to define the boundaries of quality in evaluating and treating humanity.”

The size of health care organizations matters,
Without organizations physician practices lie in tatters.

Physicians can no longer be individual practitioners,
They must be organizational and societal parishioners.

As Aetna-Humana, Cigna-Anthem, and UnitedHealth know,
size gives heft, leverage, and power to keep others in tow,

As hospitals as centers of their communities recognize,
Hospitals are the biggest game in town in scale and size.

As centralized government is knowingly aware.
Its massive spending pervades all health care.

As the huge medical-industrial complex can appreciate,
Its organizations’ size helps better contracts to negotiate.

As social media’s incredible reach and impact grows,
Everyone knows they can’t do without its cons and pros.

But size by itself is rarely, if ever, enough.
Instead the right size is needed to do the right stuff.

The VA is biggest U.S. health system by any analysis
But its rigid structure causes bureaucratic paralysis.

Medicare-Medicaid has $100 trillion in unfunded liabilities,
As the third rail of politics it has outlived its capabilities.

ObamaCare says all health plans must be the same size.
With ten essential equal benefits as the progressive prize.

Alas the price of equal benefits and outcomes for all.
Is too high, for the middleclass it is beyond the pall.

Big size alone will not satisfy desires of individual persons,
Who crave freedom, choice, access, and privacy as humans.

For them health care has become outsized and oversized,
Physicians’ roles are to downsize to simplify and personalize.

As a member of an organization, to treat every person as a human entity,
And to give that person their undivided attention and individual identity.