“The search for static security — in the law and elsewhere — is misguided. The fact is security can only be achieved through constant change, adapting old ideas that have outlived their usefulness to current facts.”
William Osler, MD, 1849-1919
Even as the healthcare reform process hit snags, it had a sense of inevitability. For decades, anyone with even a modest understanding of how the current system worked could only conclude that it was too costly, delivered too little value, was fragmented in ways that often thwart quality and safety, and was an inordinate burden on the rest of the economy. It was, in a word, unsustainable.
So the question was not whether change would come or not, but what forms it would take. And, of course, against this backdrop was the nagging worry, at least for doctors, that it would mean a further erosion of position: more intrusion and less say.
Perhaps it isn’t the practice of medicine, per se, that has become so challenging, but the environment of practice. The system can be complex, adversarial, and bureaucratic, wringing away the pleasure of caring well for patients.
Originally published 1/12/11 on Health Affairs Blog
Washington Post columnist Ezra Klein recently described the Obama administration’s consistent efforts to improve troubled private markets:
Isolate the eight key economic decisions of the Obama presidency: The intervention in the financial sector, the intervention in the auto sector, the intervention in the housing sector, the stimulus package, the health-care bill, financial regulation, and the tax deal…Where there was a market that they considered functional-but-frozen, they worked to unfreeze it.
An extraordinary traveling exhibition and lecture series from the US Holocaust Museum, Deadly Medicine: Creating the Master Race, is in my community now. The presentations describes the events leading up to the arrest of Jews and other minorities in Nazi Europe in the 1930s and 1940s, and then the depraved acts – medical experiments and genocide – that were carried out in the name of “cleansing.” There can be a tendency among Jews, like me, to focus on our own victimization, but there is a larger message and opportunity here.
It would be a mistake to think that this exhibition is only about Jews or Germans. Rather, it is about a deep sickness that all societies – even the most enlightened – can fall prey to. In recent years alone, we’ve seen horrific mass murders in Nigeria, Bosnia, Cambodia, Uganda, Armenia, Rwanda, Sudan, Congo and throughout South America, always as more stable nations stood by and watched.
There are patterns that typically occur before and after these disasters. The persecuting groups organize in ways that make them more powerful and effective. They portray the people they hate as threats, inferior, less worthy, unfeeling and sub-human. As atrocities become known, they orchestrate messages that deny any wrongdoing and deflect blame back onto their victims.