Friday, December 11, 2009

Bring Me a Rock: How Not to Fix HealthCare

The healthcare issue seems to have settled into a dance between sophistry and fear mongering. On the one hand are vague comments about healthcare being ‘broken’ and that ‘we have to act because …’ followed by loosely knit opinion; on the other hand is a constant screed that ‘if we don’t do something now…’ followed by predictions that start to sound like some Hollywood end of the world thriller.

Meanwhile, no one answers any hard questions with anything approaching real data. It would be comic if it weren’t so important. We have actors, posing as hyper-concerned citizens, telling us that we need to ‘fix it now,’ though precisely what they mean by ‘it’ is never made clear (Do they really mean they want every single piece of the healthcare industry addressed in one truly enormous piece of legislation? Teeth cleaning to brain surgery, all in one?) Nor does anyone care to define what is actually broken (if you are going to fix something, ostensibly it is broken).

But what is broken? A recent article in ‘Investor’s Business Daily’ provided the following statistics:

Percentage of men and women who survived a cancer five years after diagnosis:
U.S.              65%
England        46%
Canada         42%
Percentage of patients diagnosed with diabetes who received treatment within six months:
U.S.              93%
England        15%
Canada         43%
Percentage of seniors needing hip replacement who received it within six months:
U.S.             90%
England       15%
Canada        43%
Percentage referred to a medical specialist who saw them within one month:
U.S.             77%
England       40%
Canada        43%
Number of MRI scanners (a prime diagnostic tool) per million people:
U.S.             71
England       14
Canada        18
Percentage of seniors (65+), with low income, who say they are in "excellent health":
U.S.             12%
England         2%
Canada          6%

Was there some careful selection of the data shown? I suppose, though that last set of data are telling. Nevertheless, it speaks to facts, not hand-ringing.

One of the worst things leader or manager can do is provide guidance which is so vague or obscure as to actually make the situation worse. We have all known or worked for someone who only tells us something is wrong, but never really tells us what he is thinking or how to address the problem. We are told to ‘bring me a rock,’ and then told ‘no, not that rock. Bring me another.’ The ‘managers’ and ‘leaders’ who behave in this manner are poor managers and leaders. And usually, we find they had little knowledge of what they were trying to manage.

Congress, and a whole slew of special interest groups, are determined to ‘fix’ healthcare, though they can’t really be precise about what is broken except to say that 15% of Americans don’t have health insurance, and to constantly bang the drum that healthcare is expensive. Yet nothing in any of these proposed bills will actually reduce the amount of money we as a nation spend on healthcare, nor will it create more healthcare, nor has anyone in any of the harangues (I have seen no real debates) shown any element that will actually improve the quality of specific types of care. Is that because they can’t find something that is broken or they simply don’t know how to fix it? Or is it simply irrelevant?

Consider this: in the 1940s, 1950s, 1960s and 1970s in the US military every soldier, sailor, airmen and Marine received a yearly physical. But, as the services shrank in size in the 1970s and the number of dependents increased, there were fewer uniformed doctors and nurses to provide healthcare. The answer was that the military went to physicals every three years for everyone not on special status (such as pilots). This was done for one reason: the Department of Defense could not afford to hire more doctors and nurses. So they rationed healthcare.

Yet there isn’t a doctor or nurse in this country who will tell you that you should not have a physical every year.

Recently, the US Preventive Services Task Force, a panel whose members are appointed by the Department of Health and Human Services (those who would control our healthcare) recommended that women start regular breast cancer screening at age 50 vice 40. It is worth noting that this was based on new analysis of existing data, not any new discovery, and the final decision, according to the vice chair of the panel, was ‘qualitative’ ‘and not based on some magic number.’ Why let facts interfere? (The link to an article in the Wall Street Journal is provided below.)

The American Cancer Society disagrees. But, they are dealing with patients, not money. So, ask yourself this one question: How will government oversight increase cancer survival rates?  See if anyone has any facts.

http://online.wsj.com/article/SB126031689043682715.html?mod=googlenews_wsj

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