Why Not, Certainly? – The Well being Care Weblog


Not too long ago in The Washington Submit, writer Daniel Pink initiated a sequence of columns he and WaPo are calling “Why Not?” He believes “American creativeness wants an creativeness shot.” As he describes the plan for the columns: “In every installment, I’ll provide a single concept — daring, shocking, perhaps a bit jarring — for bettering our nation, our organizations or our lives.”

I like it. I’m all in. I’m a “why not?” man from means again, notably in relation to well being care.

Mr. Pink describes three core values (within the curiosity of area, I’m excerpting his descriptions):

  • Curiosity over certainty. The world is unsure. Curiosity and mental humility are the best solvents for unsticking society’s gears.
  • Openness over cynicism: Cynicism is simple however hole; openness is tough however wealthy.
  • Dialog over conversion: The final word dream? That you simply’ll learn what I’ve written and say, “Wait, I’ve bought a fair higher concept,” after which share it.

Once more, kudos. One may even say “transfer quick and break issues,” however the bloom has come off that exact rose, so one may simply say “take possibilities” or “assume completely different.” Perhaps even “dream massive.”

Across the identical time I noticed Mr. Pink’s column I occurred to be studying Adam Nagourney’s The Instances: How the Newspaper of Report Survived Scandal, Scorn, and the Transformation of Journalism. Within the early 1990’s The Instances (and the remainder of the world) was struggling to determine if and the way the Web was going to vary issues. Mr., Nagourney studies how writer Arthur Sulzberger (Jr) realized the affect can be profound:

One doesn’t must be a rocket scientist to acknowledge that ink on wooden delivered by vehicles is a time consuming and costly course of.

I.e., opposite to what many individuals at The Instances, and lots of of its readers, thought on the time, the newspaper wasn’t the bodily object they have been used to; it was the knowledge it delivers. Which will appear apparent now however was in no way then.  

Which brings me to well being care. Opposite to what many individuals working in healthcare, and many individuals getting care from it, may assume, healthcare is just not docs, hospitals, prescriptions, and insurance coverage corporations. These are merely the ink on wooden delivered by vehicles that we’re used to, to make use of the metaphor.

And it doesn’t take a rocket science to acknowledge that what we name well being care as we speak is a time consuming and costly course of – to not point out usually irritating and ineffective.

Why not do higher?

I additionally thought of well being care when studying Mr. Nagourney’s guide when he described the battle between the journalism aspect of the corporate versus the enterprise aspect: was the newspaper in regards to the articles it revealed, with the promoting simply there to help them, or was it actually an promoting platform that wanted the content material the journalists created to convey eyeballs to it? In healthcare, is it about serving to sufferers with their well being, or is it a means to supply revenue to the folks and organizations concerned of their care?

I.e., is it in regards to the mission or the margins?

If you happen to assume that’s too cynical, I’ll level to Matthew Holt’s nice article in The Well being Care Weblog arguing that many hospitals methods at the moment are basically hedge funds that occur to supply some care, whereas additionally creating scads of wealthy executives. Or to how an precise hedge fund is shopping for a hospital. Or to how, certainly, non-public fairness companies are shopping for up well being care organizations of all kinds, although many specialists warn the principle affect is to lift prices and adversely affect care. Or to how Medicare Benefit plans could also be higher at delivering insurer income than high quality care.

I might go on and on, nevertheless it appears clear to me that healthcare has misplaced its means, mistaking the way it does issues from what it’s alleged to be for. If healthcare has develop into extra about making a small variety of folks wealthy than about making lots of people more healthy, then I say let’s blow it up and begin from first rules.

There’s a “Why Not?”

Mr. Holt’s “Why Not?” is to take a measly $38b from the $300b he estimates these hospitals are sitting on, and make investments it in main care, such because the Federally Certified Well being Facilities (FQHCs). Main care wants the cash; the hospitals/hedge funds, not a lot. Amen to that.

A pair years in the past I proposed a fair wilder concept: let’s give each doctor $2 million – perhaps even $2.5 million – yearly. We are saying we worth them, so let’s reward them accordingly. The caveat: from that they’d must pay for all of their sufferers’ well being care wants – referrals, prescriptions, hospital stays, and many others. I posited that they’d negotiate significantly better offers with their compatriots than we appear to have the ability to do. A lot of particulars to be labored out, nevertheless it falls into the “Why Not?” class.

Right here’s one other audacious Why Not: it’s pretty well-known that CEO to employee pay ratios have skyrocketed from a modest 20-1 within the 1960’s to one thing like 344-1 now. There’s no proof I’ve seen that the ratios are any higher in healthcare. Since no career in healthcare is extra revered and relied on than nurses, I suggest – perhaps making it a situation for receiving any federal funds — that no healthcare group ought to have an govt compensation  to nurse compensation ratio that exceeds 20 (and I do imply compensation quite than wage, to keep away from the bonus/inventory shenanigans that executives have relied on). 

If that sounds low, I’d pity the chief who needs to argue with straight face that he/she is greater than twenty instances extra essential than nurses. I guess they couldn’t discover many sufferers who’d agree, or any nurses.


If you happen to work in healthcare, it’s best to ask your self: is what I do the ink, the wooden, or the supply truck, or is it actually integral to what healthcare must be in 2024?  If you happen to assume your job must be extra about well being and fewer in regards to the enterprise of well being, why not make it so?

And the remainder of us must be asking ourselves: is the healthcare we get nonetheless the equal of a print newspaper? We don’t must be rocket scientists to acknowledge that, in 2024, we must be anticipating one thing higher – cheaper, quicker, extra interactive, extra private, and far more impactful.

Why not, certainly?

Kim is a former emarketing exec at a significant Blues plan, editor of the late & lamented Tincture.io, and now common THCB contributor

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