Medicare Change: 10 Ways to Stop Improvement

Stop Sign

 

Some think Medicare means utopia; we just need more of it.  For them, change is bad.  Listed below are 10 tired quips people use to stop change to Medicare (with responses).

1. You exaggerate the problems with Medicare.

Not to people dying on wait lists.

2. Medicare worked so far; why change now?

We need to adapt or go extinct.

3. We just need more money.

Budgets never precede greatness.  Steve Jobs started in a garage.

4. You imply we – providers, bureaucrats, etc. – are a failure.  

No, you’ve done very well even without the best tools.  Imagine what we could accomplish with the right structure, aligned incentives, and patient involvement?

5. You have a hidden agenda.

That’s not fair.  Look at the good folks working to improve things.  

[BTW, this accusation works to undermine anything you want to oppose; it’s impossible to prove the absence of something!]

6. What about control?  What about accountability?  What about, what about, what about?

All great ideas raise questions; none can be answered with certainty beforehand.

7. This just sounds like [choose your favourite distasteful concept].  Favourite distasteful concepts include: American Medicine, big business, profiting on suffering, etc.

Actually, it’s not like any of those terrible things at all.  It’s about giving patients what they need, when they want it, in a way that makes them feel valued.  

8. You’re abandoning our core values.

Change upholds the values that started Medicare.  We started with an insurance program for acute needs.  We now have a warranty to cover routine maintenance.  We need to get back to our original vision and build from there.

9. It won’t work here; we are different.

True.  We are different, but people are the same everywhere.  Canada ranks next to last on many measures (efficiency, service) against European countries.  I’m sure we are smart enough to do better here. 

10. This is a slippery slope towards American healthcare [or other scary idea].

Common sense provides a guardrail.  We let 10 year olds watch TV, but we do not let them vote or drive a car.

Everyone agrees we need change; just not with Medicare.  We need adult conversations that move beyond fear mongering, confusion, and character assassination.  Change will be forced on us as the first baby boomers turn 80 in 2027.  We’ve outgrown Medicare; we must change now, or watch it fail completely.

 

Holding Patients Hostage: Medicare, Stockholm Syndrome, and Choice

stockholmpanoramaFor 6 days, captors held employees hostage in a bank vault in Stockholm, Sweden, August 1973.  Police finally rescued the victims and caught the criminals, but some employees defended their captors for days afterwards.

The Stockholm Syndrome describes the positive feelings that victims sometimes develop toward captors by mistaking a lack of obvious abuse for kindness.

Even after long waits, survivors of major illness are glad to be alive and thankful for their care in Canada.

Fear mongering about financial ruin and system change makes patients cling to a system that holds them captive to long waits with no easy options.

Debate centers on whether our system harms patients.  It does.  But, issues get dismissed as isolated, or labeled as ‘solved’ with wait-time strategies and benchmarking.

 Patient harm is the wrong debate.

 Holding Patients Hostage

We need to focus on what patients aren’t getting.  The public doesn’t really know what they are missing.  It’s up to providers to say so.  When patients finally get an MRI, they’re impressed.  Who wouldn’t be…for ‘free’!

People need to know we have an economy-car version of healthcare at a mid-sized price.  For the same or less money, better systems can:

  • Treat patients like valued customers
  • Give patients choice about who they see and when
  • Provide home or office visits
  • Provide same/next day imaging AND results
  • Offer specialist consultation within days
  • Arrange elective surgery within the week with biopsy results in days
  • Offer electronic access to records
  • And much more…

Increased Utilization

At this point, quants (quantitative analysts) say, “But that would just drive up utilization.”  Utilization equals the number of services provided.  More service means more money: always bad in a publically funded system.

 But, increased utilization is good if more patients get necessary care.

Quants see spikes in utilization as unnecessary care (even in the face of population growth).  They assume providers offer unnecessary care when allowed, fingering providers as liars and thieves.  They assume the same of patients; ergo, patients don’t deserve more care.

But, we know patients need more care; they die on wait lists currently.  We also know patients would like better service; they want more value for money and prompt care options at home, not abroad.

Food Industry Analogy

Just imagine if we socialized the food industry.  Groceries cost thousands per year, and many citizens are malnourished and poor.  Socialized food would help.  We could set prices and offer only essential items, without junk food, for free in government stores.  We could make it illegal to purchase food elsewhere.

Others have tried this: state-run food industry results in no choice, long line-ups, and terrible customer service.  Sound familiar?

 We Need Change

Medicare was built to prevent financial ruin from acute, major health needs, before modern treatment options existed.  Now, most care issues are chronic, multiple, and create arguments over the definition of ‘need’.  Medicare began like collision and theft automobile insurance, but it now covers all mechanical issues: a warranty, not insurance.

We are held hostage, unable to change.  We defend our captor mistaking lack of obvious abuse as kindness.  We must debate whether people should be free to choose more than the bare minimum of care. 

(photo credit: tripadvisor.com)

Modern Medicine Today, Miasma Tomorrow

john snow 01Nearly 2,000 people died of cholera in London, 1848.  Those who survived boarded their apartments and fled to the countryside.  Streets were bleached and sprinkled with sulfur to combat the foul odours, miasma, that experts believed caused the infection.

Dr. Snow pioneered population mapping in outbreaks.  He moved scientific thinking to adopt the water borne theory of cholera transmission: a feat far tougher than identifying the source of infection.

People believed foul smells caused disease.  They thought noxious odours or miasma infected patients.  The miasma theory of contagion held popular opinion for most of the 19th century.  In its final hours before surrendering to the water borne theory, followers lashed out with invective and calumny.  They attacked Dr. Snow and his theory.  They even used Snow’s best example and twisted it into support for the old miasma dogma.

What holds unquestioned support in medicine today that will cause incredulous moans of disbelief by clinicians after us?

(photo credit: www.westendextra.com)