Useless

Useless


Everything, these days, seems to be useless. Spend enough time exposed to the media (social or otherwise), and one cannot help but conclude that we’d better do a lot more laughing to keep ourselves from uncontrollable bouts of crying. Here’s an off-the-top-of-our-heads random list of what’s currently considered useless: government, big business, agriculture (either large commercial factory farms or local community agriculture, depending on whom you ask), alternative energy, fossil-fuel energy, the housing market in general and the ability to refinance your mortgage in particular, banks, credit unions, professional athletes, performance-enhancing drugs (see Lance Armstrong in both cases), the designated hitter, replacement NFL officials, NBA ownership, Super PACs, grassroots movements, traditional media, social media, diet, exercise, meditation and acupuncture.

Most people would add to the list any attempt whatsoever to do anything to alter the three-ring circus that we call health care. Ticket prices keep getting higher, the same bears dance, the same feats of derring-do are performed high above our heads and there’s simply not enough staff on the clean-up crew to keep the place from smelling. We’re being entertained and reassured that everything is going to be okay just like it always has, but at what cost? Long-term, we’re not going to feel – or be – better. Once we leave the tent our world is the same, and running away to join the show only works out if you’re an acrobat, an animal handler or the bearded lady.

Far too many of us seem to be following the same step-by-step play book for making health care system change seemingly useless:

  1. Point out that the system isn’t working as it ideally should, particularly because of X.
  2. Describe a particularly heinous current situation or example that serves as a perfect springboard for your health care reform position. (Sadly, there are enough readily available in sufficiently broad variety to support arguments from any angle.)
  3. Passionately argue your point to the exclusion of differing perspectives. Be as thorough and long-winded as you can on this, hopefully to the point that you have worn somebody down with your unique determination.
    Bonus step: If you can, sloganeer. Create snappy and crisp jibes that liberally play with the truth in order to inflame certain constituencies. One of the earliest examples: “Keep your government hands off my Medicare.”
  4. Step Four: Select the preferred medium, release your concoction into the wild and watch as the pot boils over in a froth of supporters and detractors.

No matter the position or argument, however, the same basic components and players are central to the system, leaving the question as to what – or who – we are really saying is useless. Are the doctors and nurses? What about insurance companies or hospital administrators? Is the person who cannot even access health care useless to you? Are you useless in your own capacities to become healthier?

The play book has become so prevalently used that we seem to have lost our basic sense of how to solve a problem, no matter how complex. It’s critical to consider where costs are out of control, who profits most or least, and who or what is most efficient as long as you don’t start there.

Throw away the play book, and solve problems the way you learned in grade school. Start with a simply-stated goal – healthier people, supported cost-effectively – and clarity emerges. It may not be pretty facing up to the inconvenient truths that emerge from a discussion oriented around a simple goal, but asking the question “how might we make people healthier?” is likely to spur stronger long-term positive improvements than “how do we reduce costs?” Imagine what could happen if we took all the people engaged in various skirmishes over proposed changes and we focused them on who and what is most useful in achieving a shared goal. Odds are pretty good that we would ultimately re-organize our communities, our built-environment, our food system, our lifestyle and the health care system around what is most useful in achieving it.

If we want people to stop calling things useless, then the way to go about it would be to get rid of what’s not useful, including distracting arguments. That’s pretty simple in the abstract, but somewhat daunting in reality. The arguments exist because stakeholders on all sides want to assert that they are not only useful, but the most essential. Complementarity is not a strong suit of the vast majority of health care system players, and Darwin has argued that competition is how we survive. In health care, the stereotype has it that the specialist has disdain for the primary care doctor, the doctor sees himself as superior to both the patient and a phalanx of nurses, physician assistants, nurse practitioners, etc. The hospital administrator must wrangle them all with authority. The insurer must set parameters over all of that. Lastly, Government must somehow demand its own efficiency and effectiveness perspective in order to deliver bang-for-the-buck to the very people who viscerally experience the direct effects of every decision. The cycle is similar when it comes to state or municipal government, or even a local neighborhood association. We are obsessed with proving our worth to each other, but that may turn out to ultimately be detrimental to our well-being and longevity when we can’t see the bigger picture or act in favor of the greater good.

Sound absurd? It is, especially when we persist in chasing our own tails in a rut of unproductive arguments while the bears keep dancing and the circus rolls on.

Never mind. It’s useless.