Sunday, August 9, 2009

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.

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