“It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.” Sir Arthur Conan Doyle
The debate over health care and over the 2010 Patient Protection and Affordable Care Act has been a classic illustration of this piece of wisdom.
The inescapable facts are these: We, the wealthiest nation on earth, spend more money per capita on health care than does any other modern nation. The outcomes from those expenditures, measured in terms of the wellness of our citizens, place it behind those of more than 25 other nations.
Should we not be asking ourselves some painful questions?
Have we been rewarding procedures to address health problems after they surface, while not rewarding, even penalizing, primary care physicians charged with keeping us healthy? If your family doctor, your elder-care physician, spends more than the limited time the present system will pay for, trying to steer you toward better long-term health, does that too often come out of his or her own pocket?
Have the incentives in our existing system thus been in the wrong place? And is the result a sick-care system, instead of a health-care system?
Does the existing system of providing and paying for your health care flunk the most basic cost-benefit analysis? Count the number of people you deal with at your doctor’s office and at the hospital who are not health care providers, who instead keep non-medical records, figuring out who will pay for your care and how much of it they will pay for. They and much of what they do are overhead. Doesn’t that overhead, which some estimate to exceed 20 percent of our health care costs, come out of your doctor’s pocket, the hospital’s pocket and ultimately out of your own pocket in higher insurance premiums and higher taxes?
And are doctors practicing unnecessary defensive medicine to avoid liability for mistakes under an outmoded system that in fact provides relief in only catastrophic cases? Do we need to find a better way of dealing with genuine medical mistakes?
Has the existing system left us too many who can find basic medical care, often too little and too late, only in the most expensive source available to them, the hospital emergency room? Are we not all paying for that?
And has our problem been compounded by a system of communication that has lagged far behind what modern information systems could provide to the doctors who treat you? If not, why does conventional wisdom suggest that if you have a serious health problem, you need to be accompanied by an advocate who knows your whole story and can monitor your treatment?
In a just society, basic health should be as fundamental as food, shelter, education and employment. The Affordable Health Care Act, which our Supreme Court has now sanctioned, is an imperfect first step, but the debate it has engendered has placed the issue squarely before us. Indeed, we are already seeing those who provide our health care, and more than a few of the insurers who pay for that care, begin to take a broader look at the problems that the debate has laid on the table and to seek better solutions.
Do we not all need to know whether changing the incentives to focus on outcomes, eliminating wasteful inefficiencies, improving and coordinating record-keeping and taking care of those now left out before their medical needs become crises would actually be less costly than what we now have? And if it is not, do we nevertheless need to weigh the cost against what we would gain as a society? Clearly we cannot do that without focusing on facts, rather than on preconceived theories.
The often misunderstood Charles Darwin once observed that, “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.”
Has the time come for all of us to set aside the ideological posturing and partisan bickering – “our side” versus “their side,” “winning” and “losing” – that has for too long clouded this issue and to recognize that in a changing world we have a compelling societal problem that can be solved only by those who are willing to look objectively at the facts and only then to begin to fashion the solutions those facts compel?
If we fail to do this, will we not all be the losers?