Healthcare Reform

There have been just so many column inches, blogs and tweets committed to commenting on healthcare reform, but something I find missing in almost all is a sense of how all the parts that make up our healthcare system is an awareness that these parts do interact; they are not independent of each other.

The link for this posting is to an editorial in the local paper, the Valley News, that was attempting to summarize a series of interviews done by a local reporter, John Woodrow Cox. In an all too typical fashion, the editorial made no attempt to synthesize the six viewpoints presented by the six individuals who were interviewed. Cox himself said that the only constant between and among the stories was a lack of consistency. Well, you might just as well throw your hands up and say, "I give up! It's too hard and no one will ever agree!" This is unfortunately all too typical of the reporting we are seeing everywhere. Is it really that hard to get someone from The Dartmouth Institute who might be able to shed some light on this?

Letter to GOPUSA.com Owner and Editor

I've been getting the daily dose of headlines from a site that states that its goal is to remind the Republican Party of their conservative base. Other than an article that questioned Sarah Palin's decision to resign early from her governorship, for which he was roundly criticized, most of the articles are typical "red meat" for the conservative base. Here is a letter I wrote to the editor:

I guess from your bio that you are well set in your ways, adhering closely to dogma, so I don't believe any feedback I may give you will cause you to rethink anything to say or do. However, I'm an optimist at heart, so here goes.
The biggest change that I saw that Barack Obama brought was a deep knowledge that problems we have today do not have simple causes and their solutions cannot be achieved by one-dimensional and dogmatic thinking. President Bush saw the world as very black and white, good and evil, so the shift in approach was very refreshing.
I believe that both Democrats and Republicans suffer from the same kind of linear thinking that most people have, so it's no wonder that Obama is having a tough time with both sides of the aisle. What I don't really get is the value-add that you think your site provides to the dialogue and discussion, unless you are not really interested in having either. Highlighting extremes of behavior or isolated events and then attempting to infer/imply that these represent everything that a person or policy or group have to offer is just plain demagoguery and only serves to allow the most base of our human instincts to flourish - outrage, anger and contempt to name a few - and not the best aspects which include reason, humility and compassion.
I have done software development for large diverse groups for more that 15 years and from that experience I can say that the best solutions come from having all stakeholders at the table, all offering what they can to find a solution. I see that Obama has attempted many times to have Repuplicans be part of the decision-making processs, but instead of stepping up to do so they have instead chosen to remain on the sidelines, whining, griping and sniping. A solution to healthcare in this country is not going to work if it is Democrat or Republican. No one of us has a lock on the Truth. We can only discover what works by working together on all this. Having people at Town Halls yelling from the back of the rooms to shout over speakers is just bad form - my mother - and yours, I would hope - would disapprove of such brutish behavior. This is not a sign of general discontent being voiced, it is a sign of poor upbringing.

Healthcare Reform and Linear Thinking

I've been listening to and reading responses from conservative Republicans to the Obama Administration's effort to reform the way health care is being performed and paid for in this country. I've frankly been astonished at the level of vitriol being issued by talking heads and bloggers on the right. You would think that Obama was one of the four horsemen of the Apocalypse and that as a result of health care reform we would all be forced to wait for hours in order to get substandard health care. Oh, wait, we already have that.

So, no it's that we will have some bureaucrat in Washington, DC deciding on whether or not we can get care. Oh, wait, we already have that...except my bureaucrat works for Aetna; but his or her role is the same: deciding on whether the care I get is appropriate or not.

So, no, it's that health care will become extraordinarily expensive if we make changes we will all be paying dearly just so everyone can get covered. Oh, wait, we already have that! Hospitals already have to charge insurance companies a premium over their actual cost since a certain percentage of their patients have no insurance or their insurance has been maxed out and so we do pay for the uninsured and under-insured. Plus a public hospital is legally bound to provide care to all, no matter if they can pay or not, so guess whose taxes pay for that?

There is a system that has grown around the payment for health care in this country that has constantly been pushed to shift costs from one group to another. As a result, in this country we have very little relationship between how much care costs and our health, as demonstrated in the Dartmouth Atlas project. So paying more does not give better care! How more non-linear can one get?

So how can we solve the issues surrounding health care reform? Not through the kind of dogma-driven arguments we have been seeing. Dogma has a very linear view of the world: there is my way (the right way) and any other way (the disastrously wrong way). Dogma is driven by belief systems not by data - just think of Galileo and the moons around Jupiter that could not exist in the Catholic Church's view of the world. Dogma is not interested in data that does not fit in to an established world-view since that data threatens the very stability of that world view.

Systems thinking relies on the kind of data that is provided by the above-mentioned Dartmouth Atlas project as well as many other Comparative Effectiveness studies. Systems and holarchical thinking value any kind of insight and data that does not fit into established ways of thinking since that is how we come to know more how a particular system works.

So a holarchical/systems view of health care looks at all aspects and contributing factors to one's health - genetics, lifestyle, family dynamics, community, socio-economic factors, environmental effects, access to care, employment, presence or lack of health insurance and one's spiritual life just to name a few - and how a health care system can be constructed to improve all our health. If we agree to put aside dogma and let data speak to us we can start the process of understanding how to move forward.