America Cannot Afford More “Cost Saving” Medical Initiatives
Incremental Agglomeration, Creative Destruction, and the Impending Forest Fire in the American Medical Establishment
Part 1: Introduction
The great promise of every medical initiative has been “cost savings.” Indeed, what magnanimous medical aspiration in print or powerpoint could preclude a fast-fact stat about the alarming overspending in American healthcare? Yet, we continue to realize these “cost saving” health initiatives, and health spending inexorably grows despite marginal improvements in care.
Electronic records, evidence-based medicine, patient-centric care, personalized medicine, universal coverage, and genomics —sure, all good as advertised, but can America afford another revolutionary “cost saving” medical industry initiative? No, because revolution is destructive, and what institution willfully destroys itself? Not institutions that still exist. So like the non-directive flaws of biological group selection theory, the drastic improvements promised by revolution are beyond incremental and self-sustaining evolution —as intellectually unaesthetic as that seems.
We forget: every new medical initiative purports revolution by some combination of better education, capacity, technology, or standards. But there’s no grand medical conspiracy inhibiting the potential of these ideas; the mundane simplicity is that change is hard work, people are busy, and everyone stakes in the status quo. Self metabolism is cannibalism —the very antagonist of successful healthcare management— so only outside competitors can metabolize the medical establishment, and while these well-minded initiatives may snuff immediate needs, rather than sparking significant change, they thicket. Procrastinate revolutionary fire, more dead paper accumulates, and greater the conflagration of healthcare.
But today, two decades of information technology has made a destructive healthcare revolution imaginable. First, medicine has matured from scholarly practice to information science, and science needs no priesthood. Next, decades of accumulated initiatives choke American healthcare in waste information, a problem information technology solves well… too well. From problems like “pager tag” to “government by bureaucracy”, the revolutionary solution destroys the existing systems and their vested interests —not by doing something different, not by central planning, but by mass computing the friction to asymptote per unit doctor. But, to metabolize a useful system takes activation energy unavailable to already stressed doctors, and business acts for its own local growth. Thus, revolution is fundamentally unachievable by insider initiatives despite plausible feasibility and best intentions.
So manifests the quintessential American pragmatic hypocrisy: all tout the wealth-building virtues of creative destruction until the torch of change is under you. Then, change is “unethical.” Only law is more artificially sustained by its own ethical sophistry and willfully abstruse erudition as is the gross establishment of American health. America hates its healthcare, revolution is coming, and no insider medical initiative can stop it forever.
Think Gene at Technorati
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