Fear and Loathing In Las Healthcare

I was shrinking my carbon footprint on the bus from Chicago trying to jot down notes about my thoughts on healthcare when the cold medicine took hold and the twisted facts everywhere began to resemble the screeching of bats. I’ve let the post rest but I’m still stuck in a rut where every time I see Harry and Louise I end up ruminating on Duke and Dr. Gonzo.

“There was every reason to believe I was heading for trouble, that I’d pushed my luck a bit far. I’d abused every rule Vegas lived by-burning locals, abusing the tourists, terrifying the help.

“The only hope now, I felt, was the possibility that we’d gone to such excess, with our gig, that nobody in a position to bring the hammer down on us could possibly believe it. …When you bring an act into this town, you want to bring it in heavy. Don’t waste any time with cheap shucks and misdemeanors. Go straight for the jugular. Get right into felonies.” Hunter S. Thompson,Fear and Loathing in Las Vegas

There are so many past patterns of power, odd partnerships, conflicts of interest and baskets of money floating around that it’s tough to tear through the rhetoric and figure out where to stand. There are a few sources that I’ve been following that seem to cut through the rhetoric rather well, mostly technical in the healthcare and economics sphere. Their arguments seldom reach the fevered pitch necessary to break into the popular media although Baseline Scenario’s recent headline tries: “You Do Not Have Health Insurance” is a great summation of the current system’s flaws. If you’re not paranoid now, read the article and it will help you along.

Paranoia reigns. Discussions are difficult. Fear of losing, fear of lacking, fear of change.

Innovate or Die

A business mantra that takes on a more sinister meaning in the healthcare debate. But true nonetheless. There is writing on the wall. The risk that healthcare will be out of your reach when you need it most is increasing and there are no guarantees that the current round of regulatory mayhem in Washington will correct course. Insurance companies like the package. Can that be good? How to judge?

I find that when fear drives change, decision-making tends to favor knowns over unknowns. Slight changes-of-course rather than liftoffs.

I hate making decisions based on fear.

Arguments fall to the level of school yard brawls, he said she said insults. Contradictory facts thrown at every issue designed to muddy not clarify. There is a lot of money in stay the course. There is a lot of power in change. The only losers in this battle seem to be individuals whose voices are muted by the roar of past patterns of power and future wanna be’s. Where can I find firm ground to add my measly little vote into the equation? How can I manage my fear to better make decisions?  I’ve decided first to limit what I’m willing to be afraid of.

These are a few of my favorite fears…

  • Loss of Access. Simple. Straightforward. Currently we are on a path where healthcare is rationed by pocketbook and employer. If you have the right job and the right income you can afford the best treatments in the world. Odds are increasing that I will not be among this lucky group. (As they are for most of us.) Which brings us to my second fear:
  • Limits To Where I Work and What I Do. Getting caught seriously, chronically ill away from a major employer has downsides. Rescissions and price increases try to drive you from the system and cause serious problems for your employer and co-workers. (Click the rescissions link to see how a .5% rescission rate claimed in congressional testimony can magically turn into 50-50 odds of loosing your insurance if you file a massive claim.) Being forced to make a job decision based on availability of healthcare has implications for the economy and democracy as a whole. Which leads to fear #3.
  • Talent Drain. America is driven by small business. It is where most jobs are and possibly where most innovation starts. It is where the rogue operatives who can’t stand corporate bureaucracy run to create beautiful things. Small business is at a competitive disadvantage in providing health insurance to their employees. If a single employee becomes chronically ill, price increases designed to force the company to drop insurance for all employees create a terrible conflict. Get the sick individual to leave or lose health insurance for all. This results in a permanent disadvantage for small business that is getting worse with time. Which brings me to my final and biggest fear.
  • Innovation Stagnation. The US has driven most healthcare innovation over the past century. Sometimes misdirected, usually expensive and often oversold as it is, it still has provided vast benefits for the world. Locking in some variant of the current system or some variant of a European single payer system could very well end rapid innovation as we know it today. Then again the right incentives could light a fire under the next wave of improvements from a different angle.

The loathing part.

We’re on a political path that involves much screaming and very little doing. We have corporations demanding to be released from regulations at the same time they craft regulations to hamper their competitors. Hypocrisy is a word I try to avoid, but it feels right here. The arguments are about power and control on both sides with progress by either side always seen as a threat to the future power base of the other. Why would we accept such a thing? Are the errors so huge that we simply can’t believe reasonable human beings are capable of making them?

Where is the radical transformation of information processes that is happening elsewhere in the economy? Where is the democratization of information going on elsewhere in the tech world? Maybe the truly radical approach to healthcare reform is not through centralization, but in radical individualization.

How can we raise the bar on this debate? Three little steps.

  1. Decide what truly concerns you and frame answers to that concern. You need a defense against scattershot arguments. If you have a solid hypothesis then you can evaluate whether an argument presented even merits evaluation given your concern.
  2. Remember that other’s fears may be different than your own. Understand the framework of their concerns and how their points fit their framework.
  3. Merge and Purge. See where your hypothesis and concerns overlap. See if you can at least agree on a problem. At this point purge arguments that are sideways – seemingly relevant but framed in a way to create conflict rather than find solution. (For example, the difference between arguing U.S. average outcomes are terrible compared to other countries vs the US having the most sophisticated medicine around. The two ‘facts’ are not necessarily contradictory – they are addressing different concerns however.)

Once again a post with more questions than answers. Must be the meds. Fear and Loathing in Las Vegas has different appeal to different folks. I’ve always seen it as a primal scream in the Las Vegas wilderness when reality, ideals and momentum simply refused to mesh up in a comfortable way. Sounds a bit like healthcare, don’t you think?

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13 Responses to Fear and Loathing In Las Healthcare

  1. Rick Hamrick says:

    Fred, you did an admirable job of describing the chaotic environment each of us as individual citizens face in trying to understand what health-care reform means.

    I do find it a little troubling that you only list your fears, and not what you hope might come out of this situation. Hell, Fred, you said in this same post that you hate to make decisions in an atmosphere ruled by fear. Why not give equal time and energy to what is possible and positive?

    Again, good job in laying out how one can think about it and discuss the issue with others who might disagree in large part, but who may also have areas of agreement depending upon their own framing of the issue. In fact, this is a decent summation of how to discuss sensitive issues of any variety. I’m going to keep your three steps for future use!

    Thanks, Fred. I appreciate access to your insight.
    .-= Rick Hamrick´s last blog ..Staying is okay, too =-.

    • Hi Rick, Fair point. Before offering solutions, my thinking was to see if anybody else was trying to understand the problems we face from the same perspective as I am. Truth is there are solutions galore being presented and all will probably fix various problems that folks are focused on. I’m just not sure we’re all talking about the same things and in some cases that means your solution might exacerbate my problem. I find defining the question being asked sometimes takes me a long way towards structuring a solution that balances competing interests hopefully in a win-win scenario. You seem to agree to a certain extent with the problems outlined, so in the next post we’ll solve the worlds problems! 🙂 Thanks for adding to the conversation Rick, I appreciate your contribution.

      • Rick Hamrick says:

        Fred–I was less interested in solutions than I was in framing the issue not only with what we fear will come about, but also with what we envision as our hopes for the reform.

        Fears often result in irrationally expressed opinions which still have, at their core, an important message for those in charge.

        Hopes often result in unrealistic expectations, yet they offer a balance to the fear-based concerns and need to be aired so that those in charge are helped toward perspective.

        So, no solutions! It is too soon. Instead, let’s complete a framework which balances what we fear with our dreams. It offers a far better starting point to begin constructing proposed solutions than do fears alone.

        Thanks, Fred!
        .-= Rick Hamrick´s last blog ..Staying is okay, too =-.

  2. J.D. Meier says:

    I agree – pain is a key motivator.

    I think you’re bumping into a common problem in the marketplace. I think BillG said it well when he said, the market doesn’t always drive the right things. I think that’s why opinion leaders are so important … they create tipping points, and they can show the latent value of things that might not be fun to do, but are important to do … and they can create glide paths.

    I think the world’s changing, but there are some very distinct patterns and we have some interesting history to learn from. We should do a think tank at some point and bounce ideas around. I’ve had the pleasure of bouncing ideas with some amazing brains and they’ve shared with me some paths for the future.
    .-= J.D. Meier´s last blog ..A Language for Strengths =-.

    • Hi J.D., The value of opinion leaders is so high and so effective that it’s easy to overlook what happens when they get to work. Ben Franklin was the master at this. Ideas for needed services would come up in various organizations that he participated in — kind of men’s clubs if I’m remembering correctly. He would encourage the idea without seeming to control the idea. Call for its implementation under various pseudonyms in his papers. Work behind the scenes and ‘tada’ you end up with libraries, fire departments and post offices. While he was a genius at creating inventions that sold in the free market, he was also quite happy to utilize other means for services that didn’t fit so nicely into the evolving capitalist system. Good point and I think a think tank could be productive.

  3. Terry Heath says:

    Boy, I need a good laugh after that one.

    I look at my parents and realize I’ll never have what they have. My dad worked all his life in jobs that took no outside skills or training, yet always had health insurance, was able to buy a home, and lived fairly comfortable. At the end, his health care footed the very large bill for chemo and the smaller one for Hospice, a God send. Eight years ago they paid for his battle with congestive heart failure, a very expensive war he won. He was surrounded by family and support until the end, and now my mom has the same thing. She never worked outside of the home, but will be able to live the rest of her days comfortable in her own home with a mid-sized pension from dad’s working days.

    But right now I don’t have insurance, don’t own a home, and fear dying alone without resources. Divorced and far from my son, I don’t see where there will be family around me when I die. I don’t say that to sound pathetic. I think it’s the situation of many people today.

    Let’s go out and spend some more money on cars. We must save all those car dealers, mustn’t we?
    .-= Terry Heath´s last blog ..Two Ways to Laugh, Two Ways to Live =-.

    • Ah Terry, I didn’t mean to depress. And you’re not alone in your situation. I think movement on healthcare has started simply because so many of us are realizing how easy it is to be stripped of the basics. When care works in our society it works very well. When it doesn’t it really doesn’t. Seems that a flip of the coin mentality towards a system so basic is not the way one would design it from scratch. There is something very primal about our emotions concerning health that are not dealt with well when talking about cost savings and allocating care. Thank you for sharing such a personal picture here.

  4. Terry Heath says:

    By the way, Fred.

    Maybe it was the cold medicine, but your writing has taken on a very Raymond Chandler tone. Perhaps you should try your hand at writing hard-boiled crime fiction a la “The Maltese Falcon.”
    .-= Terry Heath´s last blog ..Two Ways to Laugh, Two Ways to Live =-.

  5. Bill Welter says:

    Fred,
    Your “four fears” brings the message home for me. And, like Rick above, I’d love to hear your ideas. Keep ruminating — your thinking helps me think.
    Bill

    • Hi Bill, I’m hoping to chime in as we go forward, but I’m still feeling a bit like a ping pong ball. My Capitalistic tendencies are struggling with my concerns that the system is devastating as many lives as it is helping. I would love to see a system that improves competition and care but the transition to that could be horrifying.

  6. Emily says:

    Loved reading the article and all the comments! We must take the good with the bad unfortunately. Luckily it looks as though some of our government leaders are coming together regardless of party affiliation to address this issue. Thanks for this post!