Are There Any Simple Solutions to the Health Care Crisis?

Dana S Kellis MD PhD MBA

"Every system is perfectly designed to get the results it gets." Donald Berwick 

fixingushealthcare.com

Thursday, October 31, 2024

Dear Mr. President, Honorable Members of Congress and Distinguished Staff,

The complexity of health care exceeds that of any other industry in the country.  The number of people whose livelihoods depend on health care, the amount of money that changes hands in health care, the technological advances in health care, the political forces arrayed at local, state, and national levels to preserve or increase the power and economic status of various stakeholders comprise only a few of the hopelessly tangled massive steel cables that make healthcare both a nearly incomprehensible jumble as well as exceptionally resistant to significant change.

Occasionally a health care apologist, trying to defend the status quo, attempts to defend our American health care (non) system, stating such things as “we have the best ‘X’ in the world,” where ‘X’ can be doctors, nurses, hospitals, medications, technology, etc.  The truth is, unfortunately, little objective evidence supports such claims; in fact, evidence suggests the opposite; that is, that Americans have poor health care over-all.

The United State ranks number 57 among countries in the world for infant mortality, worse than many supposedly less advanced places around the globe.  Similarly, infants born in 2024 in the US have a shorter life expectancy than infants born this same year in 62 other countries.  The US ranks 62nd for “healthy life expectancy; that is, for the expected number of years one might spend in good health.  Similarly, the country places 67th in the world for “disability-adjusted life years;” that is, for the number of years citizens live unencumbered by disability, injury or diseases, meaning Americans suffer an unusually high disease burden, particularly given their high standard of living.

This brings up the issue of how much Americans spend on health care.  Not only do US citizens pay multiples of what other healthier countries’ citizens pay for their health care, they suffer egregious consequences resulting from this excess cost.  Medical expenses cause the greatest number of bankruptcies in the US.    Even Americans with health insurance face eye-watering deductibles before their insurance coverage begins, despite paying crippling monthly premiums, the net effect of which is that many Americans have to decide between food and, rent, and other necessities and health care.

In summary, the US has a health care system which provides poor care for an exorbitant price, and that has proven to be too complex with too many vested interests to be amenable to structural changes.  This, then, begs the question, “what can be done?”  Can we really continue with a status quo that delivers inferior quality at exorbitant prices, leaving many Americans with physical, mental/emotional, and economic injuries?

The answer lies beyond the scope of this composition, but it is important to understand how to approach this question.  For that, I would like to turn to complexity theory, which comes from the study of complex systems.  Simply stated, a complex system is one which responds to stimuli in an unpredictable, but effective way.  For instance, an automobile is a complicated system, but not complex, as one can know exactly how it will respond to various inputs.  On the other hand, an ant hill is a relatively simple system, but exceedingly complex, as one cannot know exactly how it will respond to different stimuli.  Health care is both complicated and complex, comprised of complicated and complex subsystems, sub-subsystems, and etc.

One of the laws of complexity states, “when the complexity of an environment exceeds the capacity of a system (to change or react), the environment will dominate and ultimately destroy the system.”  A team of explorers in the jungle, for instance, will survive only for as long as their creativity and resources exceed the threats to which they are exposed in the jungle environment.

Similarly in health care, any system implemented to structurally change the health care environment must have the ability and organizational intelligence necessary to create effective responses to health care’s constant change that exceeds the ability of health care to thwart those responses.  Reviewing statistical cost and quality trend lines in health care, which show limited improvement at best, suggests such a system has yet to be created.

In summary, simple solutions to our health care crisis do not exist.  Solutions which lack the necessary capacity to adapt to the changing healthcare environment are likely to fail and might worsen the overall health care environment through their failure.  In subsequent posts, I will review how prior interventions have failed and propose ideas for future systems.

Sincerely,

Dana S Kellis MD PhD MBA FACP 

Dr. Kellis will be pleased to hear from you.

Copy to: We The People (at fixingushealthcare.com)