Thoughts About Health Care, Part 1

In my teens and early twenties – a long time ago, in a car culture far away – I was sort of a car guy (wannabe car guy is more like it). And while I had a fairly cool, hopped-up car, it paled in comparison next to many of those you’d see cruising down the street at night, or parked at the speed shop where a lot of car guys hung out, bought parts, and/or had machine work done.

The guy at the shop that did the machine work had a sign over the counter. The sign said, “Machine Shop Work: Fast, Good, Cheap – Pick Any Two.” Which brings me to thoughts about health care. In thinking about our health care “system,” I often think of: “Cost, Quality, Access. Pick Any Two.”

Fast, cheap machine work was likely to be sub-optimal and likewise, high quality, broadly accessible health care is unlikely to be inexpensive. Or, inexpensive health care made broadly accessible may result in less than outstanding quality. Or, high quality health care that isn’t exorbitantly priced may not be broadly available. In any event, adding the third variable (any of the three) into the equation with the other two seems to further confound the search for a straightforward solution. Yet in health care, the goal of high quality, broadly accessible services that do not consume all (or even a larger than the current proportion) of this nation’s GDP is the holy grail.

Good luck with that. At the machine shop, guys (virtually all the car guys were in fact, guys) would determine whether they had alternative means of transportation, and if so, they might opt for good, cheap work (when the work involved tearing down the motor, the car would be out of commission for a while), or if they needed it fast, guys would try to figure out how to get some extra cash to pay for faster service. Interestingly, I never heard of anyone opting to trade away “good” for “fast and cheap.”

With our own or our family members’ healthcare, most of us would be loathe to trade away any of the three variables – we want access to high quality health care and we don’t want to pay too much for it. However, something has to give. At the systemic level, one area that seems to be worthy of investigation is to think about better alignment of incentives among all the participants in the health care system: the payer(s) – including taxpayers, the provider(s), the patient, the regulators, etc. Today, the incentives are not in alignment. And, if incentives are misaligned, it is difficult to believe optimal outcomes can be achieved.

More on this in future posts…
Be well.


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