Who or what IS the real problem?
Healthcare is such a chaotic mess. Why? Who is responsible? Where are the evil people keeping care from millions, making it completely unaffordable, bankrupting families and the entire country, controlling markets, preventing reform, keeping better treatment options from the masses, etc, etc, etc? Let's just deal with these grotesque villains and all with be well, right?
If you go looking for these evil people, you will have a very hard time finding them. Yes, there are definitely some bad eggs in healthcare. And these stories get cycled through the media fairly vigorously (as long as it doesn’t step on advertisers toes). But time after time, as you look for the decision-makers who are evil and malicious and mercilessly putting the screws to patients, you only find people trying to do their jobs. And the vast majority of the time they want to do good — they want to help people.
Basically good people “just doing their jobs”…. So how does that work? Why do millions of intelligent healthcare workers “just doing their jobs” function as such a mess?
To really understand this, we need to take a step or two back and look at the big picture. You know those experiments where you boil a frog in water by turning the temperature up slowly enough so that he never tries to escape? Well, that’s us in healthcare. We are lapsing into brain-melt unconsciousness. Our goose (or frog in this case) is pretty well cooked. Caring for the sick, injured, or dying has almost always historically been based on mercy and compassion for each other, often stemming from a spiritual impetus to love each other in reality and in practical terms. That is the fresh, cool, flowing water. Healthcare has increasingly become mercenized, commercialized, bureaucratized, impersonal, corporate. To the point that medication after medication, even old and generic ones, are becoming vehicles of extortion for exorbitant price gouging. We are witnessing the financial sector of society preying on the physically weak among us, time and time again, and no one is stopping it. It has become the norm. “Pay us way more than is reasonable, or any normal person can afford, or suffer and die.”
The reality of healthcare today is that there are many, many good people, wanting to help those of us in need of physical help, trapped in a bad systems. Fifty years ago, if presented with the options of mercy-based care vs commerce-based care, everyone in healthcare would have been absolutely horrified of the thought of the latter and would want nothing to do with it. They probably would have passed laws against it if they could even bring themselves to think that it could ever be possible. But here we are.
In 1961, just months after the start of the trial of Nazi war criminal Adolf Eichmann, Stanley Milgram did experiments at Yale University to try to understand how normal people in the role of common Nazi soldiers could commit such atrocities. These experiments are considered a major stain on the history of the United States and of medical research. Normal people were instructed by an authority figure to administer increasingly more powerful shocks to a test subject while the test subject was screaming in pain from the previous lesser shock. It was “shocking” to what lengths good, normal people (including "professional people," and "white-collar workers") could be led to apparently torture and nearly execute their fellow man. They were “just doing their job” as part of the research. The research context and a researcher led them to think this was somehow OK. Our context, environment, authority figures, and apparent norms are, in reality, the major drivers of our morality or ethics in practice. That is terrifying in the context of modern healthcare. Especially when we realize that Nazi soldiers and citizenry were taught that their mission was noble and they were making the world a better place.
All right…all you frogs out there…who still have some semblance of consciousness: it is time to wake up and remove oneself from the kettle. Collectively we need to turn off the stove, and re-establish our connection to the wellsprings of human compassion as the basis of all healthcare. This is a HUGE change. It means changing systems. No it won’t be easy. But it sure beats the alternative.
As Patients United we are the change we would see in healthcare.