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Fixin' Healthcare

Wednesday, May 31, 2006

The Lifestyle Chronicles - Demand And Need

Perceived needs become demands that become needs. Consumers and providers alike reinforce this process. It is a process that fosters continuing regeneration of need and refinement of need. There is competition between needs but needs are mutually supportive to grow the overall enterprise. This is commerce and it is the American way. In medical care this process has become a "perfect storm". Nothing personal, it's just business.

There are numerous examples of this process in action ranging from universities (billion dollar capital campaigns), to hospitals (deploying the latest technology, building new wings and advertising that I'm bigger and better than the other guy), to professional and speciality associations (a powerful urge to procreate and protect turf), to pharmaceutical and medical device corporations (the masters of advertising to create demand and need), to patient advocacy groups (usually specific diseases with high public sympathy), to foundations (imaging worthy causes). All of these are well-meaning, worthy of support and ultimately self-serving. All of them suffer from linear thinking. Treat the need and find more of the need.

The medical care enterprise does not change; it enlarges and becomes more refined. New technologies and methods are added in layers to grow the enterprise without disturbing what is already there. Any increase in effectiveness is directed more to the process than the outcome. Diagnosing and treating the need has made little progress toward the cure or prevention of the chronic diseases that generate need. For these reasons, efficiency has steadily declined.

Creating greater capacity to address perceived need is not an answer for health care in America. The task is to define the need and create the enterprise for greater capability of achieving optimum health status for everyone. And, we had better start before everyone is an invalid, bankrupt or dead.

Now, I am begining to understand Kafka.

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