American Elephants


The Social-Engineering Approach to Health Care by The Elephant's Child

John Goodman offers two fundamental ways of thinking about complex social systems: the economic approach and the engineering approach.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice.

Goodman, the father of the health savings account, calls this “cookbook medicine” which gives doctors rules and protocols for treating patients with various symptoms, and they must record each step along the way. Cookbook medicine does not bother with the differences among people, and is the opposite of personalized medicine which aims to tailor the therapy to the characteristics of the patient.

While it is useful to consider the standard protocols, people are not all the same. Medicine adapted to the genetic makeup of a person is in its infancy, but shows promise. When the cookbook becomes a rulebook to be followed slavishly, we’re in trouble. When complying with endless checklists takes valuable time away from patient care — that’s what’s happening in American medicine. A recent study of emergency room physicians found that they spend more time interacting with screens than patients, clicking the mouse 4,000 times in a 10-hour shift.

The Affordable Care Act was heavily influenced by the engineering model. After all, our bureaucrats are certified experts, and what are experts for if not to tell everybody else what to do and how to do it. Only social engineers would think of running “pilot programs” to control health care costs. What is the purpose of a pilot program if not to find something that appears to work, so you can order everyone else to copy it. Therefore you have the mess of digitizing all medical records and the result that hospitals have different systems that cannot talk to each other?

Dr. Virginia McIvor, a pediatric physician at Harvard Medical School explains the problem:

When a healthy child visits, I must complete these tasks while reviewing more than 300 other preventative care measures such as safe storage of a gun, domestic violence, child-proofing the home, nutrition, exercise, school performance, safe sex, bullying, smoking, drinking, drugs, behavior problems, family health issues, sleep, development and whatever else is on a patient’s or parent’s mind. While primary-care providers are good at prioritizing and staying on time — patient satisfaction scores are another quality metric — the endless box checking and scoring takes precious time away from doctor-patient communication.

If you have been to a doctor recently, you have probably noticed the multiplication of forms you must fill out, questions you must answer. I have noticed that the form now contains a line for “refuses to answer,” which may indicate progress of a sort.

John Goodman is the father of the “health savings account” which works precisely as promised and has been a great favorite. He is president of the National Center for Policy Analysis (NCPA) and he blogs regularly on health care matters (you can sign up to receive his columns), and his book Priceless takes on the health care problem.

There are great things happening in medicine that are promising for the future. The engineering rulebook is not interested in other people’s expertise or innovation.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412


Wreaking Havoc on Healthcare, the Economy, Freedom and the Obama Legacy. by The Elephant's Child

The fabled and troubled website for enrolling in ObamaCare is, um, not going to meet the December 1, deadline., but we knew that in the  beginning. This is not a plan for improving health outcomes for the American people. It is entirely about social planning and redistribution of income. Forcing everyone to be “equal.”

Obama goes to great lengths to call the private insurance policies that we liked — “substandard”— because they don’t include the generous benefits of the four ObamaCare plans: bronze, silver, gold and platinum. What “substandard” means is that people were free to choose insurance that did not meet Obama’s social equity and income redistribution goals. Some people must pay extra for poor policies so others can pay less and receive extra benefits.

ObamaCare planners believe that they can mandate a rich level of “essential” health benefits that all individual plans must cover — regardless of cost. This year eHealth reported that its data show that individual premiums must be 47% higher than the old average to fund the new categories in the individual market.

The rules imposed by ObamaCare are resulting in a decidedly inferior product. Then new mandates raise costs, so insurers compromise by offering narrower and less costly networks of doctors, hospitals and other providers in their ObamaCare policies. For example pediatric vision care is mandated for all, even those who are childless or have grown children, and in exchange parents cannot take their really sick kids to splendid institutions like Seattle’s Children’s Hospital.

Obama has seemed remarkably uninterested in the details of his health care policies. He simply does not want to be bothered with details. If his project for transforming America is proceeding apace, that is what is important. Providing everyone who cannot afford the higher prices of the most basic plan with Medicaid is not improving health care for anyone. Because few doctors will accept Medicaid patients, wait times will be long, and outcomes are worse than for those going uninsured.

Canada’s population is around 36,137,500, and they are trying desperately to find ways to turn their health care back into a closer doctor/patient relationship. Wait times are far too long, and you can get a CT scan for your dog far sooner than you can get one for yourself. The population of the U.K is roughly 63,705,000, and not only failing, and killing the elderly, but going broke. But the Democrats in Congress are sure they can devise a plan for some 317,000,000 by forcing the entire population into four plans because one-size fits all. No need for diversity, well, except for favored constituencies like Unions, members of Congress, and whatever is the need for the next election. Pete du Pont commented:

ObamaCare embodies the usual hypocrisy of large liberal programs, as the administration bestows benefits and exemptions on favored constituencies and the politically connected. We see waivers for big labor, relief from inconvenient mandates for congressional staff, and decisions timed to minimize harm to Democrats in the next election. Conversely, those who don’t have politically correct views are ignored or mocked. We see lip service given to conscientious objections to abortion and birth control, but ObamaCare policies that run roughshod over these objections.

Perhaps most disappointing, we can observe in the administration’s handling of ObamaCare a now all too familiar subversion of the rule of law, a fundamental precept of our nation’s founding and of democracies everywhere. George Will notes that the administration has apparently decided it can adopt legislation by press conference as Mr. Obama simply announces changes to the law or that he will not enforce certain provisions. His administration then proceeds to strong-arm businesses and demonize critics.

There is the usual governmental failure to anticipate how people respond to economic incentives. Why would the administration expect the required large numbers of healthy, young people to enroll in ObamaCare in response to higher premiums? Why would the administration expect businesses to refrain from adjusting their staffing decisions based on the additional cost of ObamaCare?

It’s “coverage” not care, and if you think your new policy is expensive — wait till you see how much it costs next year — after the election, of course.




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