Inform Me!
No need to feel insecure, Canada. You're the best at something!
Yeah, you're the best at feeling insecure!
Fortunately for you, this isn't my rant for today. The predictable way for this rant to start, at least in Canada, would begin with how woefully inadequate and inefficient our healthcare system is.
Again, how fortunate you are today, for I want to begin with how our system is quite good. This being a blog, I'm not held to actually back that up for you; if you want to challenge my, as yet, unsubstantiated claim, I'll see you in the comments. Canada's health system really is quite good. By that I mean, our health system is measurably more effective and more efficient than the American health system in any statistical measure, and that's the only thing that counts, right? Being better than the Americans?
Wait a minute, maybe only comparing yourself to the United States is a silly idea. After all, it has the highest public spending per capita on health care being used to cover the smallest proportion of its citizens... (let alone residents).
When considering reform to your health system, you certainly appear unable to look anywhere but the United States. Well, maybe that's not fair, but you really seem to still be solidly convinced that neoliberalism is the way forward, and the United States, more than any nation on the planet, has insisted on applying the principles associated with the neoliberal consensus to their health care.
The largely debunked consensus figures, to increase efficiency in all manner of government services, governments ought to, at least, allow for market forces. At most, this 'application of market forces' can mean the government cutting loose a service completely and contracting someone else to do it. A convenient example of this is water testing in Ontario in the late-90s, early-00s. That worked really well, right?
Sorry, Canada, I don't mean to snark. Let's reach back to ECO100 and look at the theory behind this consensus. In general, the free market model is believed to be rather efficient, mostly because of a cascading system of greed:
- Mr. W enjoys material possessions, power, or some other good obtainable through money.
- Mr. W owns Company W.
- Company W makes and sells widgets.
- The widget sales minus the manufacturing costs are Company W's profit.
- Company W's profit lets Mr. W get more of those delicious goods.
- If Mr. W can find more economically efficient (aka. cheaper) ways to make widgets, more of the sales will be considered profits.
- The more profits Mr. W can find, the more lovely little money-related things he can do.
Thankfully, this isn't the whole picture. Mr. W alone would have to be the devil to act solely upon greed. It takes a board of owners aggregating their greed to do that. As I said, this isn't the whole picture, there's another layer:
- Mr. D, like Mr. W, enjoys goods obtainable through money.
- Mr. D owns Company D, which makes and sells dongles.
- Company D uses Company W manufactured widgets to manufacture its dongles.
- Mr. D, like Mr. W, wants to make his manufacturing more efficient, in order to maximize profit by minimizing costs, because it will mean he can obtain more of his money-obtainable goods.
- Since the cost of widgets makes up part of the cost to manufacture dongles, and Mr. D seeks to minimize all those pesky manufacturing costs, Mr. W's greed is kept in check by Mr. D's.
This system continues up and up the chain: Company T uses widgets in their thing-a-mees, so Mr. T seeks to minimize their cost, putting Mr. W's greed in check. However, unlike turtles, this isn't quite the same all the way up. Maybe 'cascading system greed', because it's more like layers of greed overlapping in a circular path:
- People working at Companies W, D, and T all like stuff on some level.
- Some stuff is really stuff they need; other stuff, they just want, like Messrs. W, D, and T want stuff.
- Many of these People, like Messrs. W, D, and T, seek to maximize the quantity of stuff they can obtain.
- However, they don't have quite as much control as Messrs. W, D, and T, so they simply seek to obtain the greatest stuff-related satisfaction for each unit of money they spend.
- S-Mart, owned by Mr. S, sells stuff.
- Stuff is a category including a variety of things, like those thing-a-mees we talked about earlier.
- Mr. S, acts much like Messrs. W, D, and T and seeks to maximize his profit by minimizing costs.
- Since S-Mart sells thing-a-mees Mr. S's layer of greed overlaps with Mr. T's, helping limit Mr. T's greed.
- Finally, Mr. S's profits are kept in check by all those People who are looking to maximize their satisfaction per spending unit.
Sorry Canada... That's more or less it. I thought that model was going to be much quicker to explain. Free market economics in a nutshell. You can see, though, that it is really quite a neat little package, but there're a few things that mess with this model a little bit.
Firstly, even circular flows of energy are not perfect and energy is lost to, let's say, entropy. Touching slightly on economic entropy, we can see a more important quality of the market model: the People want to maximize their satisfaction per spending-unit, probably what makes this model so effective, but they don't always know how. Various kinds of socialization, like advertising, teach the People how to measure satisfaction, but this doesn't always work.
One of the clearest cases of the People not being able to function in the system as 'rational actors seeking to maximize value' is when the value of a thing is unrelated to its cost. (Aside: In my view, forgetting this is the source of much unhappiness in the western/northern world.) To bring us back to the topic du jour, one of these interesting cases is that of health care.
Imagine Canada, you're a patient presented with a number of options to treat a serious illness. As you're weighing these options, when is the rational time to consider their economic cost? Alright, let's move things up one level, you, Canada, are a doctor with a number of options for treating your seriously ill patient. As you're considering the options, when is the rational time to consider their economic cost? We can keep going if you like, but instead, I'll just leave the question open: at what level does it make sense for you to consider the economic costs of a treatment option?
I don't think there is. Now, I hear you complaining about how I've only framed the question as an economic one. Well, there's a reason. The free market model is... gasp... an economic model! The personal incentives it attempts to capture in order increase efficiency are, fundamentally, economic. Health care is, fundamentally, an effort to minimize suffering. Are you ready to assign a clear monetary value to suffering? If not, you're not ready to rationally judge the value of minimizing suffering in an economic model like the free market model.
I'd like to take the position that we should pay for any effort to minimize suffering because its value is unrelated to its economic cost. Don't get me wrong, it's still a very good idea to try to minimize these economic costs, but because in health care, we're not able to relate them to their value, we should probably stop trying to fit it in to a market model.
I see you're working on electronic health records with the Canadian Health Infoway thing? Great idea! Pushing bits is dramatically less costly than pushing paper, especially when you're talking the volume of records with which a hospital deals. It also doesn't interfere with the practice of medicine solely towards the minimization of suffering.
You say it's just an effort to invest in the private sector in order to encourage the adoption of EHRs? I know it's got great buzzwords like "P3", but have you judged the value of this approach? Fortunately, gains in efficiency, unlike minimizing suffering, can be assigned clear economic values. Time to behave like a rational actor, jackass.
By the way, this nearly made me shit myself:
"Gone are the days of doctors as sole practitioners," he says. Instead, physicians will work in groups at major clinics. "The chief doctor will have regular Monday morning meetings with staff. They'll pull up data on the thousand patients they manage at the site, and look at trend analysis for say, their 25 diabetics to see how they're dealing with them."
Yeah, you're the best at feeling insecure!
Fortunately for you, this isn't my rant for today. The predictable way for this rant to start, at least in Canada, would begin with how woefully inadequate and inefficient our healthcare system is.
Again, how fortunate you are today, for I want to begin with how our system is quite good. This being a blog, I'm not held to actually back that up for you; if you want to challenge my, as yet, unsubstantiated claim, I'll see you in the comments. Canada's health system really is quite good. By that I mean, our health system is measurably more effective and more efficient than the American health system in any statistical measure, and that's the only thing that counts, right? Being better than the Americans?
Wait a minute, maybe only comparing yourself to the United States is a silly idea. After all, it has the highest public spending per capita on health care being used to cover the smallest proportion of its citizens... (let alone residents).
When considering reform to your health system, you certainly appear unable to look anywhere but the United States. Well, maybe that's not fair, but you really seem to still be solidly convinced that neoliberalism is the way forward, and the United States, more than any nation on the planet, has insisted on applying the principles associated with the neoliberal consensus to their health care.
The largely debunked consensus figures, to increase efficiency in all manner of government services, governments ought to, at least, allow for market forces. At most, this 'application of market forces' can mean the government cutting loose a service completely and contracting someone else to do it. A convenient example of this is water testing in Ontario in the late-90s, early-00s. That worked really well, right?
Sorry, Canada, I don't mean to snark. Let's reach back to ECO100 and look at the theory behind this consensus. In general, the free market model is believed to be rather efficient, mostly because of a cascading system of greed:
- Mr. W enjoys material possessions, power, or some other good obtainable through money.
- Mr. W owns Company W.
- Company W makes and sells widgets.
- The widget sales minus the manufacturing costs are Company W's profit.
- Company W's profit lets Mr. W get more of those delicious goods.
- If Mr. W can find more economically efficient (aka. cheaper) ways to make widgets, more of the sales will be considered profits.
- The more profits Mr. W can find, the more lovely little money-related things he can do.
Thankfully, this isn't the whole picture. Mr. W alone would have to be the devil to act solely upon greed. It takes a board of owners aggregating their greed to do that. As I said, this isn't the whole picture, there's another layer:
- Mr. D, like Mr. W, enjoys goods obtainable through money.
- Mr. D owns Company D, which makes and sells dongles.
- Company D uses Company W manufactured widgets to manufacture its dongles.
- Mr. D, like Mr. W, wants to make his manufacturing more efficient, in order to maximize profit by minimizing costs, because it will mean he can obtain more of his money-obtainable goods.
- Since the cost of widgets makes up part of the cost to manufacture dongles, and Mr. D seeks to minimize all those pesky manufacturing costs, Mr. W's greed is kept in check by Mr. D's.
This system continues up and up the chain: Company T uses widgets in their thing-a-mees, so Mr. T seeks to minimize their cost, putting Mr. W's greed in check. However, unlike turtles, this isn't quite the same all the way up. Maybe 'cascading system greed', because it's more like layers of greed overlapping in a circular path:
- People working at Companies W, D, and T all like stuff on some level.
- Some stuff is really stuff they need; other stuff, they just want, like Messrs. W, D, and T want stuff.
- Many of these People, like Messrs. W, D, and T, seek to maximize the quantity of stuff they can obtain.
- However, they don't have quite as much control as Messrs. W, D, and T, so they simply seek to obtain the greatest stuff-related satisfaction for each unit of money they spend.
- S-Mart, owned by Mr. S, sells stuff.
- Stuff is a category including a variety of things, like those thing-a-mees we talked about earlier.
- Mr. S, acts much like Messrs. W, D, and T and seeks to maximize his profit by minimizing costs.
- Since S-Mart sells thing-a-mees Mr. S's layer of greed overlaps with Mr. T's, helping limit Mr. T's greed.
- Finally, Mr. S's profits are kept in check by all those People who are looking to maximize their satisfaction per spending unit.
Sorry Canada... That's more or less it. I thought that model was going to be much quicker to explain. Free market economics in a nutshell. You can see, though, that it is really quite a neat little package, but there're a few things that mess with this model a little bit.
Firstly, even circular flows of energy are not perfect and energy is lost to, let's say, entropy. Touching slightly on economic entropy, we can see a more important quality of the market model: the People want to maximize their satisfaction per spending-unit, probably what makes this model so effective, but they don't always know how. Various kinds of socialization, like advertising, teach the People how to measure satisfaction, but this doesn't always work.
One of the clearest cases of the People not being able to function in the system as 'rational actors seeking to maximize value' is when the value of a thing is unrelated to its cost. (Aside: In my view, forgetting this is the source of much unhappiness in the western/northern world.) To bring us back to the topic du jour, one of these interesting cases is that of health care.
Imagine Canada, you're a patient presented with a number of options to treat a serious illness. As you're weighing these options, when is the rational time to consider their economic cost? Alright, let's move things up one level, you, Canada, are a doctor with a number of options for treating your seriously ill patient. As you're considering the options, when is the rational time to consider their economic cost? We can keep going if you like, but instead, I'll just leave the question open: at what level does it make sense for you to consider the economic costs of a treatment option?
I don't think there is. Now, I hear you complaining about how I've only framed the question as an economic one. Well, there's a reason. The free market model is... gasp... an economic model! The personal incentives it attempts to capture in order increase efficiency are, fundamentally, economic. Health care is, fundamentally, an effort to minimize suffering. Are you ready to assign a clear monetary value to suffering? If not, you're not ready to rationally judge the value of minimizing suffering in an economic model like the free market model.
I'd like to take the position that we should pay for any effort to minimize suffering because its value is unrelated to its economic cost. Don't get me wrong, it's still a very good idea to try to minimize these economic costs, but because in health care, we're not able to relate them to their value, we should probably stop trying to fit it in to a market model.
I see you're working on electronic health records with the Canadian Health Infoway thing? Great idea! Pushing bits is dramatically less costly than pushing paper, especially when you're talking the volume of records with which a hospital deals. It also doesn't interfere with the practice of medicine solely towards the minimization of suffering.
You say it's just an effort to invest in the private sector in order to encourage the adoption of EHRs? I know it's got great buzzwords like "P3", but have you judged the value of this approach? Fortunately, gains in efficiency, unlike minimizing suffering, can be assigned clear economic values. Time to behave like a rational actor, jackass.
By the way, this nearly made me shit myself:
"Gone are the days of doctors as sole practitioners," he says. Instead, physicians will work in groups at major clinics. "The chief doctor will have regular Monday morning meetings with staff. They'll pull up data on the thousand patients they manage at the site, and look at trend analysis for say, their 25 diabetics to see how they're dealing with them."