Present - January 7, 2007 - early evening

More about Health Care: This is my response to the kind note from Warren Redlich (aka Albany Lawyer) on my blog of January 2. I am still trying to perfect my understanding of the blog structure and what goes where, so it is likely that there is a more appropriate way to keep a thread alive about a topic, but I don't exactly see it. I could comment on the comment, but that seems a silly thing to do in my own blog. Anyway. I spend a good deal of time thinking about the health care system, as a system, and trying to understand what actions might be key leverage points to creating a more economically sustainable, humane, and effective system. I cannot claim to have reached any conclusions. Yet. So in answer to Warren's question about how to pay for the layer of low-tech services I was proposing, I must confess that I do not have a workable economic model in mind. But here is what I was thinking. There is a lot of money in the health care system today. A significant portion of it goes to dealing with health problems that are chronic (i.e. keep costing money) or ones that have reached a critical stage. To what extent are these costs a result of: (1) failing to completely solve a problem once it presents (presuming that one can -- I know that there are many constraints on this), (2) having a system where problems present later than is optimal for effective treatment, (3) problems presented that are entirely avoidable, and (4) [variation on #1] sending someone home without adequate support to prevent the recurrence of the problem. It seems to me that the actions needed to address these four sources of cost are low-tech, not high-tech. (This reminds me a little of the shibboleths in IT Project Management that the multi-million dollar failures are almost never traceable to technology problems and almost always to relationship and behavioral issues. Of course, the IT world is responding to this belief by devising technologies to deal with it.)
My son cynically pointed out that I am describing the dream of "managed care" which was a failure. I don't think that we really tried managed care. First of all, I think that we tried "managed care" like downsizing was trying "reengineering the corporation". You can't decide that you will reduce the maintenance costs for owning your car by deciding that half the time you simply won't fix the thing making a bad noise. That doesn't support maximizing car longevity and it doesn't make the owner's experience more pleasant. Such an approach increases long-term costs as well as complaints from owners. My second comment on "managed care" is that health is quite personal, as are most of the behaviors associated with good maintenance. Folks need to trust their coaches on these matters and neither healthcare providers (who responded to lower revenues with the 90 second doctor visit) nor insurers (who have some work to do to build trust that they have a real interest in member health) built a trust foundation for managed care. Indeed, I can't see evidence that anyone had any goals unrelated to the bottom line costs and recompense for health service delivery. The goal of managed care was intended to be better health through routine maintenance as a mechanism for reducing the cost of repair services. No one focused on the goal.
My final comment on this subject is that I have watched a few interviews with Bill Gates, Warren Buffet, and the Intel guy (my apologies for forgetting his name -- I will research and correct this note) on their global health care initiatives -- that have led me to feel hopeful that you can combine structured systems thinking with humanitarian instincts and devise disciplines that, if practiced, can meaningfully change health outcomes. If this approach was applied to the US health care system, I think we could begin to see improvements. The goal of more healthy people more of the time would, IMHO, be the most effective way to pull costs out of the healthcare system.
So, in answer to Warren's question, I think that coaching, social networking, nagging, holistic assessment, & support services that seek to take care of the non-technical issues of wellness and recovery would pay for themselves because there would be more wellness and more complete recoveries.