Further complicating the issue is the question of whether healthcare is a "right." The Declaration of Independence lists the rights to "life, liberty, and the pursuit of happiness." It is doubtful that healthcare was debated in 1776, so it leaves us with a contemporary question unique to our times.
Rights, however, are always balanced with responsibilities. Our rights to liberty and voting are balanced with our responsibility to be law-abiding citizens. Shirk the responsibility, lose the rights. Those who advocate a "right" to healthcare will also need to enumerate the responsibilities required to enjoy it and not abuse it.
Symptoms are Camouflaging Causes
The healthcare debate is badly off course because it has dealt with symptoms and has failed to address the causes. The current debate is about how to get healthcare insurance coverage (and thus care) for everyone with some question about how to pay for it. This addresses the appearance of the problem, not its causes.
Because there are many causes behind the healthcare dilemma the country faces, it makes finding solutions especially problematic. Here are some of the contributing causes:
1. There is no healthcare "system."
2. The focus is misplaced on health care instead of healthy living.
3. The possible costs for healthcare technology and services for everyone exceed a realistic share of personal income from those able to pay.
4. The marketplace is distorted so the usual consumer-driven dynamics do not work to promote improvement and cost reduction.
5. Who pays for healthcare and how they pay is convoluted and hidden.
6. In the absence of significant personal wealth, the unpredictability of health makes risk-sharing through medical insurance a necessity.
7. An aging population naturally increases healthcare needs and costs.
8. Entry to the healthcare profession is expensive and the field is understaffed.
No Healthcare "System"
There is no healthcare "system" in the United States. A system is, by definition, "a regularly interacting or interdependent group of items forming a unified whole." There is nothing unified or whole about the U.S. medical system. It consists of a multitude of diverse providers in every locale, a multitude of insurers including the government, and a vast array of policies and procedures through which they do business – much of which is not standardized across groups. It does not rise to the level of a unified system and it is therefore incredibly difficult to increase its productivity and cost effectiveness.
Improvements to individual elements like hospitals are necessary, but not sufficient to improve the "system" as a whole. Any attempt to improve healthcare must begin with improved standardization, communication, and coordination through shared policies, procedures, practices, and information networks across the nation.
Healthcare may require a paradoxical solution – mass customization. That is, "producing goods and services to meet individual customer's needs with near mass production efficiency." In healthcare, it is standardizing operations while adapting them to the unique needs of each patient. Health services are distinctly different from industrial systems in that the incoming raw material (the patients) is subject to wide variations. (No intent here to dehumanize patients, just trying to draw a comparison.) Most processes require a consistent input to run correctly. Variations in human beings require health service providers to adapt their processes across a wide range of inputs. This complicates standardizing processes to achieve efficiencies. Healthcare providers can borrow from industry, but probably not replicate it.
As an example of changing the entire system, imagine for a moment, a USB thumb drive medical "card" that contains all pertinent patient information required when registering at a doctor’s office or hospital. It eliminates all paperwork for registration across all providers. That standard card contains the customized data for each patient. Patients, or staff when authorized, could update certain data on the drive. The drive would trigger an automatic notification to the provider regarding insurance coverage whenever the drive was used for patient registration. That would eliminate the questions about whether insurance coverage was current. The magnetic strip on a credit card works in a fashion like this. This is not intended as a flawless example, just a way to see a systemic change.
At last someone put a finger on the problems. Good work. I think this business about there being no system is why people want the government to take over. At least that way everything is done the same. Private industry wants to do everything differently from company to company. That's nutty and costs money in my book.
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