What do I mean by “everything?”
If you are an American who has been paying attention to the general state of the republic, you know that our healthcare system is plagued by serious problems. You may believe that it is broken beyond simple repair, that it is already too late for incremental reforms of the sort that politicians commonly talk about, and that instead it requires a complete restructuring, that we need to blow it up and start over. But whether the present state of American healthcare elicits in you a revolutionary fervor or just moderate consternation, if I were to ask you what is wrong with it, your answer would likely depend on who you are or what your role is with respect to the healthcare system.
If you are a patient you might complain of avaricious HMOs, distracted doctors, or the difficulty of getting decent health insurance. If you’re a doctor you’ll carp about demanding and litigious patients or managed care organizations and government agencies that swamp you with paperwork and won’t let you practice good medicine. If you happen to be a managed care executive or a Medicare official, you will fume over doctors who use too much expensive technology on too many grasping patients-patients who (you’ll mutter) refuse to make lifestyle choices to prevent their expensive illnesses in the first place. If you run a biomedical company, you’ll bemoan the regulators who live only to prevent you from introducing your life-saving inventions to the marketplace. And if you’re one of those regulators, you’ll complain about a fickle public whose whining results in your being constantly hauled before congressional subcommittees, today for rushing unsafe products to market before they are fully tested, tomorrow for delaying the approval of critical medical products for the sake of your self-serving bureaucracy.
Like blind men feeling an elephant, we see the problems troubling the healthcare system as being narrow, well defined, tractable-and personal. We see solutions with a false sense of clarity: to fix healthcare we should institute universal health insurance or pass tort reform or let market forces reign or loosen FDA regulations or tighten FDA regulations. And we have a hard time understanding why the politicians and policymakers refuse to institute whichever simple fix we’ve set our hearts on.
