How to Fix Medicare: If Publicly Funded, Then Privately Run

Parents guilt children into eating vegetables with, “You should be happy; kids starve in Africa!”  

Canadians guilt patients into accepting long waits and no care options with, “You should be happy; medical bills bankrupt Americans!”

Indeed, we should always be grateful.  Looking for better ways to do things doesn’t imply ingratitude.  It demonstrates commitment to excellence.

Designed to Fail

Great organizations meet customer needs.    Great companies offer outstanding products and service at a competitive price… and treat their employees well.  In these companies, CEOs support management to help staff serve customers.

Medicare does the opposite; it serves system needs and sees patients as cost centres.  In publicly run organizations, CEOs support management to help staff spend as little as possible by providing good enough care to avoid revolution.

Politicians and their bureaucrats create regulations and controls that leave administrators and front-line professionals little room to innovate, or incentive to do so.

Good People

Politicians and bureaucrats are good people.  They get loads of criticism no matter what they do well.  I’m thankful that quality people still run for office and work in political bureaucracy.

Politicians and bureaucrats are intelligent individuals caught in a poorly designed system with perverse incentives.

Motivation

If we consider a businesswoman operating her own store, she must keep customers happy with great service, selection, and quality, or she will go under.  No matter how well she manages everything that goes into running a store, if she stops valuing customers she will shut down.

If our businesswoman worked for Medicare, her most important job would be to keep her superiors happy.  More than anything else, she must manage those above her.  If she does not, she risks her position and hopes for promotion.  This is true for every level of Medicare, from front-line providers up through every level of manager and bureaucrat.

Job security motivates administrators; they have to keep bureaucrats happy.

Job security also motivates bureaucrats; they have to keep politicians happy.

Elections motivate politicians.  They have to keep voters happy. Voters respond to marketing and handouts, not tough decisions that might disrupt the status quo.  Better to make no decisions than to risk making a poor one that will upset voters.

When politicians, and by proxy, bureaucrats, control Medicare, the focus becomes staying in office – winning elections, keeping their jobs – not serving customers.

Inefficient

We do not need more money; we need less regulation.  (See How to Fix Healthcare: Let Leaders Lead)  For the same cost, government corporations that go private produce 47% more, and are 27% more efficient, than privately run corps. (Download Fraser Institute 2009 report)

We need to let professional care providers figure out creative ways to meet patients’ needs at a local level.

We need to unleash the creative energies of individual nurses, physicians, and allied care providers.  We need to support them and reward them for creative ideas that improve patient service and efficiency.

Our Own Fault

Until we redesign the system so that good people – politicians, bureaucrats, and administrators – get free of having to pursue perverse results, we will never have a great healthcare system.

If system leaders aim for anything before great patient service and outcomes, we will never improve things; we will always suffer from a system governed to produce job security.

Let’s put patients – service, results, and quality – back in the spotlight.  Let’s stop thinking about elections, job security, or anything else, before patients.

Photo credit: www.gomomentum.com