Small Children & Washington: Magical Thinkers

A recent newspaper article reported that, instead of reducing Emergency Room visits, the self-styled Healthcare ‘Reform’ Act (HR 3590), will increase visits to these already over-burdened facilities. Washington’s prediction of reduced ER visits was another demonstration of magical thinking.

Small children are magical thinkers. Ask any psychologist, pediatrician or parent. Magical thinkers believe that because they want it or can conceive of it, “it” is so or will be so. The magically thinking child ties a cape on his back and KNOWS he can fly. When he jumps off the roof, he will of course fall, not soar like Superman.

Those in Washington – both Congressional leaders and the White House – are magical thinkers. Because they say it, “it” will be. If House Speaker Pelosi says that HR 3590 will save money, it must save money. If President Obama says that the Bill will increase care, reduce errors and improve quality, it will happen (because he said so).

The reason most adults do not don capes and jump off roofs is evidence. They may have tried it as a child and have the painful evidence in memory of a broken leg. They may read in the newspaper or see on TV the evidence of what happened to a child who tried it. They may simply consider the centuries old evidence about gravity and deceleration injury.

Is there evidence about healthcare, evidence that Washington ignored? Absolutely!

“HR 3590 will save money.” Every entitlement Program ever enacted has: a) cost more than projected, and b) spent money we did not have or do not have. No entitlement Program EVER saved money. There is overwhelming evidence to prove this.

“HR 3590 will provide care for 30 million uninsured Americans.” Is there evidence to confirm or refute this? Again, yes. Take the experience with Medicare, Medicaid and all other government health insurance programs.

If Medicare pays less than the doctor’s cost-of-staying-in-business (which it does), then the doctor CAN NOT (this is not a question of will not) accept a Medicare patient. If having Medicare insurance guarantees the doctor will not see you, then having government insurance guarantees that you will NOT GET CARE: the opposite of what was promised. Unfortunately, things are even worse than that.

Having any kind of insurance – government or private – may not guarantee getting care. Evidence shows a 20% fall-off in applications to U.S. medical schools. Forty percent of physicians in their prime are considering early retirement. There is hard evidence about our nursing shortage: over 500,000 positions are presently unfilled. So even if you had insurance and even if it paid well, you cannot get care if there are no nurses or doctors. Having insurance does not equal receiving care, and magical thinking will not make it so.

“HR 3590 will reduce errors and improve quality.” This is more magical thinking or worse, a WMDc (weapon of mass deception). To do either – reduce errors or improve quality – providers must learn. That means taking risks and easy access to lots of data, including bad outcomes. Evidence shows that the tort system, the security tightening of HR 3590, and FDA draconian regulations are killing healthcare’s ability to try new things and learn.

Magical thinking by children can harm them. Magical thinking by Washington can kill us. Those with power in Washington are not children, but they think like children, magically, and ignore the evidence.

We tolerate magical thinking by children: that is part of childhood.
Why do we tolerate such behavior in our ‘Representatives?’

System MD

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#1 Mary Ann Orzech, MD on 07.21.10 at 5:25 pm

This blog post has given me food for thought. Magical thinking is not a leadership competency.

In the Albuquerque Journal ( 21 Jul 2010) the headline appears “Presbyterian Aims to Ease ER Traffic.” To ease the traffic the Presbyterian Hospital ER will direct patients who are not emergencies to urgent care centers or primary care providers. All patients will be evaluated quickly and get a medical exam. Those patients whose health will not be compromised by a 24 hour delay in treatment will be scheduled with an appointment with an urgent care center or primary care provider’s office. They will also help the patient find a long-term medical provider. “Presbyterian’s surveys show patients who do not need emergency care show up in the emergency room because it’s convenient.” The hospital anticipates that when more people are covered by health insurance – they will have to absorb them and want to do it smarter.

Emergency departments are going to have to be proactive – but will that be enough?

#2 deanewaldman on 07.22.10 at 7:58 pm

Dr. Orzech,
I like your phrase “Magical thinking is not a leadership competency.” With your permission, I will exercise the “most sincere form of flattery” (GBS? HL Mencken?) and plagiarize it. Of course, I really hate your phrase because it is too true. Our leaders consistently believe their own rhetoric and often project an aura that suppresses any subordinates who have data not in concert with the leader’s magical thinking.
Do you recall the initial estimate by the CBO saying H.R. 3590 would COST over $1 trillion? Then magically, a statement came out saying no, sorry, it would SAVE $1 trillion dollars. The latter was probably induced by the White House reaction to the first estimate.
It is good to see Presbyterian being pro-active and what they are doing makes good sense. However, estimates suggest these policies will decompress possibly 10-15% of current volume and when the XX extra millions of uninsured have health insurance (presumably by 2014), the ER flood will be tsunami proportions.
I write “xx millions” because the # of uninsured was temporarily altered. This was not magical thinking but an unabashed WMDc (Weapon of Mass Deception). The official estimate of uninsured Americans touted throughout early 2010 was 45-47 million. Reports showed that roughly 25% of that number were illegal residents, (and by the way, another 25% already qualified for existing government assistance programs.) When it became clear that the issue of free health care for illegal aliens was so a polarizing that no healthcare Bill could ever pass, then, abracadabra, the number of uninsured Americans become 30 million, by simply subtracting the number of illegals. Talk about cooking the books, or as in the prologue to the movie Michael Clayton, “The truth can be adjusted.”

Please comment on other blogs on this (Medical Malprocess) site. Please access, read the book Uproot U.S. Healthcare, and then add your voice to the discussion. Also, I will shortly be starting an internet radio show – Your health, OUR Healthcare – specifically for the purpose of expanding the national dialogue. I hope you will listen in and speak your mind.

Deane Waldman
System MD

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