Accept No Substitutes – (Part 3 of 3)

This is the third and final post urging that YOU DECIDE. You can evaluate any Plan to fix healthcare using “A Quorum of Questions and a Chant.” Taken from my book Uproot Healthcare, this simple guide helps you decide for yourself: will the Government Plan give us what we want or not? Is it a real fix or a fix that fails? The first four (of five) test questions were provided in blogposts on October 31 and November 14.

Question 5 (of 5)
Are they thinking in lines or in loops?

“Thinking in lines” means looking only at expected outcomes and having no feedback. If you “think in [causal] loops” as we all should, you consider all possible outcomes and you build automatic feedback into the system.

John Donne said it best – “No man is an island” – meaning of course that no one and no-thing exists in isolation. What you do here affects there and what happens there impacts here. Also, the Butterfly effect is real. What you do in healthcare affects education, manufacturing, legal, and finance, and in turn they affect healthcare, often disproportionately.

Any healthcare Plan that does not consider impacts beyond healthcare is incompletely conceived. Such a Plan is guaranteed to produce unintended, unpleasant even dangerous consequences.

When our State budget was out of balance, they fixed the budget by reducing expenditures, specifically cutting “unnecessary” programs like asthma prevention. This balanced the budget but had consequences well beyond the fiscal. The next year, asthmatic children stayed out of school more and ultimately dropped out. Parents who had to stay at home with their sick asthmatic children lost their jobs. And – no surprise to anyone who thinks in loops – the following year’s budget was again out of balance because costs went up for treating patients hospitalized for asthma (attacks that could have been prevented.

The whole “thinking in loops” concept is discussed in greater depth and nicely illustrated in my book Uproot Healthcare.

If the government Plan for Healthcare describes only the effects in healthcare and fails to consider other, outside consequences, reject it.

Accept no substitutes.

Remember that thinking in loops requires effective feedback. This “second half of a loop” is even more important than the first half – the one that generates initial effects. In order for anything to improve, there must be feedback to whoever makes decisions.

The major reason we have so many regulations that do not work and that seem immortal and un-killable is simple: there is no effective feedback to the people who pass the regulations. The same is/will be true with any Plan for healthcare. To have effective feedback, those who decide must be affected by their decisions.

What if we said that all legislators had to sign up for whatever Healthcare Plan they passed into law? Remember what Ronald Reagan said: “If you want to improve the mail system, just pay the postal workers by mail!”

If the government Plan for Healthcare has no effective feedback to those who decide, reject it. Accept no substitutes.

And Finally, Your New Mantra
Show Me The C/B!

After you answer the Quorum of Questions including #5 above, you should recite over and over: Show Me the C/B! Do it just like Cuba Gooding, Jr. did in the film Jerry Maguire when he chanted, “Show me the Money!”

Whatever they say the initial cost will be, quadruple it at least. (Medicare cost >800% of the government’s original 20-year cost estimate.) Most important: accept NO cost estimate without a corresponding benefit estimate.

• For X dollars, how many people will be returned to good health, measured how?
• Allocating Y dollars for prevention and treatment of obesity (or diabetes or asthma, etc.) will improve health by what amount, measured how?
• If we give Z dollars to child health, what effect will it have on infant mortality in the USA?
• In other words, what are we getting for the dollars we spend? Show Me the C/B!

What we should care about is not the initial cost. We need to know the long-term cost (including avoided costs) for the long-term (measured) health gain. THAT is the C/B we should demand. If the Plan cannot show us this, reject it.

Accept No Substitutes.

That’s it: A Quorum of Questions and a new mantra. Use them to evaluate any proposed Plan for Healthcare. YOU answer the questions. YOU repeat the Chant. Then you decide. Trust no one: not the Government official pushing the Plan; not self-styled experts; not me. YOU DECIDE: is this Plan something you should support or is it more sound bytes; smoke and mirrors; or snake oil?

System MD

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