Under peace’d, over crisis’d

I don’t know about you, but I am truly sick of the healthcare crisis. There is a new crisis every year at health insurance renewal season (coming soon!), and then at least a few liberally sprinkled in between renewals.  Epi-pen pricing is our most recent, which Time magazine says is “yet another sign of coming Pharma Crisis”.  Aetna’s leaving several states’ insurance exchanges – there’s another one!crisis

It begs the question whether the healthcare situation is actually a crisis.  And what purpose does that label serve or hinder?  I turned to that trusty, mystery-solving tool known as the dictionary.

1 a :  the turning point for better or worse in an acute disease or fever

b :  a paroxysmal attack of pain, distress, or disordered function

 c :  an emotionally significant event or radical change of status in a person’s life <a midlife crisis>

2 :  the decisive moment (as in a literary plot)

3 a :  an unstable or crucial time or state of affairs in which a decisive change is impending; especially :  one with the distinct possibility of a highly undesirable outcome <a financial crisis>

b :  a situation that has reached a critical phase <the environmental crisis>

Not seeing decisive change impending in healthcare?  Me neither.  Decisive change does not seem possible, given the complexity of relationships, profit-makers, policy-makers, patients, and throw in a little life-or-death too.

We’ve had many programs and interventions and payment schemes that have tried to be that decisive change, bend the cost curve, bring incentives into alignment, and end the crisis.  For example, Health Maintenance Organizations promised to do all of that in the 1980s; and every decade since then have pushed out a new innovation full of promise and ultimately not full of much else.

My favorite part of Webster’s definition is the “paroxysmal attack of disordered function”.  Paroxysmal means “sudden outburst of emotion”.  It’s hardly been sudden, but it certainly has been emotional, and “sustained bout of disordered function” is the best description I’ve heard yet of U.S. health care.

If healthcare were truly a crisis, surely in these 30 plus years, we would have come to that critical phase, that turning point that is the essence of crisis.  Instead, we have muddled forward with un-decisive changes and continued to bear ever-rising costs.  It’s not a crisis.  It’s a chronic and slowly worsening condition, a commerce consuming almost 20 cents of every dollar.

My hopes, to the extent I have any, are pinned on reference pricing.  Give patients a budget for their hip surgery, for instance; they can go to providers who charge more by paying the difference.  The same goes for drugs, office visits, procedures, and treatments.  This won’t be the decisive change that ends the crisis, but it will slow down the complications of our chronic condition.  And that is the most I think we can hope for. 

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