Every Democratic candidate now has a health care plan and every Democratic candidate’s health care plan is wrong. Why? Because the American health care system almost killed me and none of the plans does anything to insure it won’t happen again.
In the years since my experience I have asked was it merely an anomaly—an isolated example of bureaucratic and clinical bungling—or a signal that something was wrong with the system? Being a systemic thinker, my inclinations lay toward the latter. Besides I felt that most of the people who cared for me were genuinely interested in my well-being, but were constantly constrained by more systemic problems.
As Peter Senge has pointed out to me numerous times, problems usually lie not with people but with the system. The health care people who cared for me did not set out to kill me, nor did the HMO that oversaw the process. In fact the bungling ended up costing the HMO far more than was necessary.
As I have talked with people inside and outside the American health care system I have come to see my case as more symbolic than unique. Many others have had similar experiences and, tragically, some of them did not make it out alive. Moreover the unnecessary costs of my case and the rigid rules that caused them were hardly unique—as we all know cost is a big issue in American health care.
Tragic deaths and the costs of providing care have been part of health care ever since curing injuries and diseases became the province of people who make this calling their life’s work. We like to believe we have progressed beyond those shadowy, even occult beginnings, yet for most of us health care remains largely a mystery yielding an occasional miracle.
Ask anyone in the world if they had one country to pick in which to be seriously ill and the odds are that the answer would be the United States. And that answer would be wrong. While our medical technology, our complex transplant surgery, and our miracle drugs inspire something akin to awe from the rest of the world, what is generally less known—even by most Americans—is that in what health care experts regard as key measures of a system’s true effectiveness our performance is mediocre.
For example, a UNICEF report on child well-being in rich nations ranked us 24th out of 24. In Critical Condition, reporters Donald Barlett and James Steele provide some sobering statistics about our health care system, which some still think is number one. They report that in a World Health Organization ranking of national health care the United States ranks 37th, between Costa Rica and Slovenia! Our infant mortality rate of 6.9 deaths per 1,000 live births trails Japan’s 3.2, Sweden’s 3.4, and France’s 4.6 among other countries. Life expectancy is this country is less for both men and women than in many European and Asian countries. (pp. 13-14)
But the most chilling statistic of all is largely unknown to most of the American public and the major reason why all those health care plans are not worth the paper used to print them and the exorbitant fees paid to the consultants who wrote them. Do you know what the third leading cause of death is in America behind heart attacks and cancer?
Take a guess. You’ll probably rack your brain trying to think of which disease it might be–and you will have wasted your time. According to Barlett and Steele, depending on which statistics you use, the third or ninth leading cause of death in the United States is medical mistakes.
What I refer to as the paradox of American health care has become one of the most crucial questions of our times: how can we have such advanced technology, skilled professionals, and exemplary research and yet at the same time rank so poorly in so many key measures? That something is wrong with the system has been the staple of political and talk show rhetoric for several decades. Scarcely a campaign passes without candidates offering this or that fix.
The paradox asks all of us whether we are getting our money’s worth. Many of us do not need to consult health care statistics to give an answer. Virtually everyone I know can relate a horror story–some major, some minor–of an encounter with the system. Michael Moore’s latest cinematic broadside, Sicko, is packed full of them. Here the paradox becomes intensely personal for what statisticians term the Lake Wobegone effect seems to operate in many of our minds. Other people may have stories, but our doctors, our nurses, our clinics are all above average.
The main problem with the system concerns not cost, but performance. I truly believe that if all of us thought we were getting what we paid for the issue of cost would evaporate over night. Concerns about cost in fact mask our unspoken fears that those statistics and anecdotes are trying to tell us something we may know is true but do not want to hear. This may not be the best place in the world to get sick.
I do not say this lightly–both of my parents were doctors. My wife is a professor of Nursing and medical researcher. Many of our friends are in the health care field. They also can talk for hours about the mistakes they have witnessed, some legitimate accidents, some the result of incompetence and some the result of what can only be called deliberate neglect.
Most politicians and the media seem obsessed with variations on a call for universal coverage or like Michael Moore issue indictments of HMOs, drug companies, and a cast of villains that has become familiar to anyone who has followed the issue. Most of these people advocate changing the system, many of them proposing some variation of a single payer system that guarantees care for all.
Which brings us to all those Democratic candidates’ health care plans, most of which owe something to the idea of universal coverage, but dodge the single payer issue in part because they don’t want to anger the insurance companies and even more out of a fear the GOP will once again raise the old battle cry of “socialized medicine.” In the end none of this matters if the care we get is mediocre.
In fact none of the presidential candidates much-ballyhooed healthy care plans seems to recognize medical errors as a serious issue or propose how to deal with them. The AFL-CIO has identified health care as one of their major issues for the coming campaign, but their emphasis is on cost not errors. Both organized labor and the candidates like to toss around the phrase “quality” health care, but it is unclear what they mean by it.
Before we start running off half-cocked, we need to understand why the system produces so many errors, otherwise the errors will continue no matter what plan we put in place. Even more ominously, systems thinkers will tell you the worst thing you can do is to tinker with the system without understanding it–and if we don’t understand why the errors are occurring we don’t understand the system. This kind of tinkering can actually make things worse, like the do-it-yourselfer who tries to fix a plumbing leak or wiring problem and ends up flooding the house or causing a electrical fire.
There are a fair number of what systems people call mental models out there about why there are mistakes, but which are true? In a sense we have before us in American health care all the ingredients of a murder mystery a who-done-it that asks not so much who personally is most guilty of needlessly killing thousands of people every year, but what policies, procedures, and methods are responsible?
Are mistakes caused by HMO policies that leave doctors’ and nurses’ hands tied so that they cannot give patients the care they need? Are they caused by hospital staffing procedures and mismanagement? Are they caused by the failure of professional organizations to police their own malefactors? Are they caused by lack of health coverage so patients die because they cannot afford the care they need? Are they caused by lack of what health professionals call health promotion, the lack of needed information that might prevent mistakes? Finally, are mistakes caused by patients themselves who self-treat in ways that can be fatal or who wait too long to call the doctor?
At the moment I have no answers to these questions–nor, unfortunately does anyone else. Until we do, we will continue to tinker with a system no one really understands–and people will continue to die unnecessarily while the politicians spew forth more reams of worthless paper.
Afterword: Readers feel free to add your own experiences with health care mistakes to the comments section.
Print Posted by: liberalamerican
