Consensus – general agreement of all parties – is usually a good thing. We just need to agree about the right things or like lemmings, who also consensus, we will in unison fall of the edge of the cliff.
In October 2005 Business Week, TJ Mullaney wrote that we had achieved “consensus of futility” referring to a general agreement among our populace that healthcare was simply unfixable. The phrase has always stuck with me because it is so pervasive, from the bottom to the top of the power structure. Everyone believes that healthcare is insoluble. We need to agree on the opposite.
We need a consensus that healthcare IS fixable.
Next we need a consensus of desires. Many believe that we have a consensus on what we want: living a long time with good health. Sure, but at what price: how much of our national resources and who is responsible to pay? Is health care given to everyone, or just everyone who is a legal citizen, or just everyone who pays taxes, or just people under the age of 90, or or or? Is there a line and where do we want to draw it? Does the patient have responsibilities and if so, what are they?
These are difficult, painful questions that we must answer openly and together. Right now, because they are difficult and painful, we avoid them. We pretend that we all agree. But we do not, and without a consensus on desired outcomes, we cannot fix anything.
Second, we need a consensus of desires.
Then we need a consensus on diagnosis – the etiologic diagnosis, or causes of problems. Right now we know the symptoms. We experience them every day: escalating costs; errors and bad outcomes [they are not always the same]; limited access; and shortages of all kinds. To fix them permanently, we need to treat their causes, not them. Gaining that consensus is the reason for this blog, so that eventually, the general public – those with the need and the power to make change – will demand substantive change in the system. Interestingly, if we agree on the diagnosis, the proper treatment will naturally follow.
Third, we need a consensus on diagnosis.
To fix healthcare, we need the right consensuses [plural].
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