Value in Healthcare
Berth and I had a rather spirited discussion about how we in the U.S. might be able to pay for the healthcare of our citizens. Being ever practical, and also owning the job of writing the checks that pay for the “health insurance” our company offers its associates (including us), Beth in effect is arguing for a national consensus on something we might describe as a baseline ‘value’ for healthcare. Others would label her concept a ‘floor’, but you get the idea.
What Beth intuitively understands is the tension between cost, quality, and convenience. You pick a baseline or a floor and offer that to everyone. With training as a nurse and 20 years in healthcare administration, her idea of what constitutes the sum of cost, quality, and convenience naturally overweights the integers for cost and quality: outcomes should be essentially equal across the board at the baseline or floor level, and the costs of achieving that should be in some way equitably shouldered by something we could describe as “society”. Very practical. A strategy that lends itself to being observable and measurable.
What’s the rub? Well, only two of the three elements that make up value are covered. To obtain an agreed upon level of medical outcomes (mortality, morbidity, longevity, etc.) the cost is covered. Ah, but HOW you obtain those outcomes is still a variable. It is the FLOOR of value that is guaranteed. Our family is experiencing a bit of this right now with Beth’s Mom. She is living in a setting that is providing excellent care at a reasonable cost, but it is a setting that does not provide any extras; it’s old, not very pretty, and she will soon have a roommate. Her (and her daughters’) experience, what we might call “convenience” in our formula, has been found to be lacking.
Therein lies the problem with any discussion about literally anything that we might discuss as a “inalienable right”.
If we examine food, something we are very conscious of in the CrossFit world, we find something quite similar. No one among us would say that X Million people should go without food. Indeed, we don’t even really talk about true hunger in the U.S. anymore, we talk about “food insecurity”, the concern that we may become hungry. By the same token, though, no one asserts that everyone is entitled to the same quality of food. Not even a little bit. No, quite the contrary, all that is discussed is cost and convenience (access).
Now, of course, we in the CrossFit world (and to a degree in the medical world) argue that quality is an ineluctable part of nutrition, that one must extend the equation outside of food alone so that an explicit choice is made that prioritizes quality calories over other purchases. While this is accurate and proper we can reasonably quarantine nutrition and keep it separate from other needs I believe, at least for the purpose of our discussion. The universal concept of the interplay between cost, quality, and convenience holds true in nutrition/food on a global, grand policy making level:
You can pick any two, but only two, when you are declaring what is the minimally acceptable level.
My formulaic approach to the coverage of needs has a little wrinkle that should be mentioned: quality cannot be increased ad infinitum. In all examples we might evaluate there is a practical limit to the ability to improve quality. The law of diminishing returns arrives in the form of asymptote as quality rises. On the other hand, cost and convenience are unbound and can rise almost infinitely. If there is one, it is the alcohol in a drink that confers the health benefit, or in the excess, the adverse effect; the same outcome occurs no matter what you drink. One person’s jug wine from Costco is another person’s Chateau Lafite served in the Gulfstream V. The same is true for food: the protein content is the same in Salisbury Steak as it is in Steak au Poivre.
You get the picture.
What will become of our conversations about issues such as healthcare? Will we arrive at a similar juncture to the one we have now in food, clothing, and shelter? Where quality (outcomes) and cost issues are addressed and everyone is left to make their own call on convenience/experience? Beth can’t see how it can be any other way. Me? I’m much less optimistic. That old “want vs. need” thing just keeps popping up. Confusion arises when a truly generous people confuse what people want with what they need. Need is measurable and therefore finite, whereas want is neither. We can, and should, all work to pick up the check for the needs of each of our brothers and sisters. “Want”, on the other hand, is the proverbial “free lunch”.
TANSTAAFL.
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