It always starts with a general feeling of malaise. For someone who very rarely gets sick, there’s a tendency to bluster your way through it. “I’m fine.” “I never get sick.” “I’m from pioneer stock.” “I’m sure it’s nothing.” “I'm pretending it’s not happening.” “I’ll suck it up.” “Mommy.”
We all know what it’s like to get very sick. It is a horrific condition. How your whole world narrows in focus to this physical unwellness, and it throws into stark relief how little much else matters when your physical self is suffering. When it happens, it’s a quick catapult off the mountain of Maslow’s Hierarchy to land face-down at its base, breathless and aching. You go from pondering the social life of information to lying curled up in bed with your only wish just to be well. We always take for granted the is-ness (health) when it’s been awhile since we’ve experienced the not-ness (not healthy).
Everyone who is not pathological wants to be well. We share this very basic need because of our common humanity. The corpus of human knowledge doesn’t always have the tools to make us well. But sometimes it does. When we see others suffering and have the tools to alleviate the suffering, we have to make a decision on whether we will use them. What makes us human is our empathy for each other, especially when we know what it is like.
As a nation with limited resources, it is a hard choice to take away from one person and give to another. Or it should be a hard choice, one we don’t make lightly. We said when this country was founded that every person was entitled to life, liberty and the pursuit of happiness. Different political parties might put a different spin on the interpretation, but I think the founders intended this as assurance that no one would take away our birthright, not that we would depend on government and the kindness of others for these entitlements. We are responsible for maintaining our birthright and no one else. Our happiness and very lives are bound up in our free will, in our ability to find spaces and create, to shape the trajectory of our own lives, to choose. Some people define poverty as the lack of choice.
So let us not fool ourselves – every time we take away from one person and give to another, we steal options from individuals. When we rob Peter to pay Paul, we shouldn’t forget that Peter gets hijacked. There is a cost, a tradeoff. This is not frivolous. But if you do the thought experiment of closing your eyes and imagining a world with zero taxes, then 10% taxes, then 30% taxes, then 70% taxes, then 100% taxes – really, take that moment and ponder on the chaos of zero taxes and the enslavement of 100% taxes, and the relative miseries and enablements in-between – you’ll understand that the conversation is not about the extremes but about that tradeoff. We forget this sometimes when we take a principled stance.
If nearly all people who get sick want to be well, if addressing sickness will cost an individual enormous amounts of money unexpectedly, if we as human beings have said that we must offer succor when we see others in a truly desperate state of suffering, then we need to come together and figure out how to share that risk. We don’t always know who will get sick and how sick they will get. This is at the heart of why we have government in the first place. This is one of the millennia-old reasons why we are social creatures. Risk-sharing is why we began to live in groups.
We need to make hard decisions about what we will pay for and what will be left to the private sector, but we have to go beyond as well. Consider our creaky hulk of a health care system, a monster and a travesty. Imagine how inconvenient and unpleasant the average health-care interaction is, compared to, say, a trip to the Apple store or a purchase on Amazon. It burdens us all. Health care, like education, is not simple but should be administratively simple. We need to strip away all the barnacles that are not related to the business of providing the right care to the right patients in the right place in the least amount of time possible. We’ve solved much harder administrative problems in other arenas, e.g. Amazon, Dell, Southwest, Li & Fung. We have the foundational technology but we need to actually use it in the delivery of health care. We need to carefully unravel the tangled web of regulation that inhibits innovation; offer transparent, credible and understandable information to patients; streamline and standardize the currently shoddy business of diagnosis; use expensive doctors for specialized activities (e.g. surgery, specialty, rare conditions); provide data and tools to compare quality of care across providers; provide toolkits to patients to manage their own care (from home, if possible); restructure payment around health rather than services; and establish public metrics for everyone.
It’s obvious that the recently passed health care reform is far from perfect. We have a ways to go to get from here to there. But where we were going was unsustainable and law-making has always been a shaky zig-zag of a walk. At least we are moving. Unfortunately, human beings tend to respond only to constraints and we are now facing constraints of gargantuan proportions.
We all know what it’s like to get very sick. It is a horrific condition. How your whole world narrows in focus to this physical unwellness, and it throws into stark relief how little much else matters when your physical self is suffering. When it happens, it’s a quick catapult off the mountain of Maslow’s Hierarchy to land face-down at its base, breathless and aching. You go from pondering the social life of information to lying curled up in bed with your only wish just to be well. We always take for granted the is-ness (health) when it’s been awhile since we’ve experienced the not-ness (not healthy).
Everyone who is not pathological wants to be well. We share this very basic need because of our common humanity. The corpus of human knowledge doesn’t always have the tools to make us well. But sometimes it does. When we see others suffering and have the tools to alleviate the suffering, we have to make a decision on whether we will use them. What makes us human is our empathy for each other, especially when we know what it is like.
As a nation with limited resources, it is a hard choice to take away from one person and give to another. Or it should be a hard choice, one we don’t make lightly. We said when this country was founded that every person was entitled to life, liberty and the pursuit of happiness. Different political parties might put a different spin on the interpretation, but I think the founders intended this as assurance that no one would take away our birthright, not that we would depend on government and the kindness of others for these entitlements. We are responsible for maintaining our birthright and no one else. Our happiness and very lives are bound up in our free will, in our ability to find spaces and create, to shape the trajectory of our own lives, to choose. Some people define poverty as the lack of choice.
So let us not fool ourselves – every time we take away from one person and give to another, we steal options from individuals. When we rob Peter to pay Paul, we shouldn’t forget that Peter gets hijacked. There is a cost, a tradeoff. This is not frivolous. But if you do the thought experiment of closing your eyes and imagining a world with zero taxes, then 10% taxes, then 30% taxes, then 70% taxes, then 100% taxes – really, take that moment and ponder on the chaos of zero taxes and the enslavement of 100% taxes, and the relative miseries and enablements in-between – you’ll understand that the conversation is not about the extremes but about that tradeoff. We forget this sometimes when we take a principled stance.
If nearly all people who get sick want to be well, if addressing sickness will cost an individual enormous amounts of money unexpectedly, if we as human beings have said that we must offer succor when we see others in a truly desperate state of suffering, then we need to come together and figure out how to share that risk. We don’t always know who will get sick and how sick they will get. This is at the heart of why we have government in the first place. This is one of the millennia-old reasons why we are social creatures. Risk-sharing is why we began to live in groups.
We need to make hard decisions about what we will pay for and what will be left to the private sector, but we have to go beyond as well. Consider our creaky hulk of a health care system, a monster and a travesty. Imagine how inconvenient and unpleasant the average health-care interaction is, compared to, say, a trip to the Apple store or a purchase on Amazon. It burdens us all. Health care, like education, is not simple but should be administratively simple. We need to strip away all the barnacles that are not related to the business of providing the right care to the right patients in the right place in the least amount of time possible. We’ve solved much harder administrative problems in other arenas, e.g. Amazon, Dell, Southwest, Li & Fung. We have the foundational technology but we need to actually use it in the delivery of health care. We need to carefully unravel the tangled web of regulation that inhibits innovation; offer transparent, credible and understandable information to patients; streamline and standardize the currently shoddy business of diagnosis; use expensive doctors for specialized activities (e.g. surgery, specialty, rare conditions); provide data and tools to compare quality of care across providers; provide toolkits to patients to manage their own care (from home, if possible); restructure payment around health rather than services; and establish public metrics for everyone.
It’s obvious that the recently passed health care reform is far from perfect. We have a ways to go to get from here to there. But where we were going was unsustainable and law-making has always been a shaky zig-zag of a walk. At least we are moving. Unfortunately, human beings tend to respond only to constraints and we are now facing constraints of gargantuan proportions.
RSS Feed