Don McCanne, MD makes two key points about competition in healthcare in his 6/14/2012 commentary, “Artificially Creating Dysfunctionnal Competition through Limited-Network Plans“. Although he is responding specifically to a 6/12/2012 New York Times article by Abby Goodnough called,”Navigating the Healthcare Maze“, these two points are worth considering in the context of any of our healthcare problems.
Excerpting from Dr. McCanne’s commentary:
“One of the greatest strategic errors in this entire health care reform process has been to fixate on the promotion of competition in the health care market.”
“Competition is a divisive, destructive, evil force when it occurs within a system that should be joining together in cooperation for the public good.”
I think his comments stand alone in shedding light on one of the biggest underlying problems we have in healthcare today and that is that our collaborative efforts, including are competitive spirit are not harnessed for the public good.
We lack an explicit collective national vision of what healthcare should be and instead have a implicit one that is driven by fortune-making.
The Institute of Medicine (IOM) was on the right path a few years back when they were creating a vision and few simple rules for healthcare reform in their book, Crossing the Quality Chasm: A New Health System for the 21st Century. Basically, the IOM committee recognized that true reform could occur by following the principals of Complex Adaptive Systems (CAS). (One of the best and quickest ways (10 pages) to understand how CAS work can be found in Appendix B with Paul Plsek’s piece entitled, “Redesigning Healthcare with Insights from the Science of Complex Adaptive Systems“. )
Unfortunately, the committee never quite provided a good enough and clear enough vision of healthcare. Since it is the stage from which everything else emerges, I believe it would be worth revisiting. In my idealistic way of thinking, a US vision of healthcare could read something like this:
The United States of America pledges to provide healthcare safely, compassionately and cost-effectively to all citizens while prohibiting fortune-making in all sectors.
I believe if we can take a step like this, we can then work on developing simple rules to guide us. Competition doesn’t have to be evil, but it can be and the trick to turning it around lies in channeling our creative competitive spirit in a more positive direction.
“Vision translates mission into truly meaningful intended results – and guides the allocation of time, energy, and resources. In my experience, it is only through a compelling vision that a deep sense of purpose comes alive.”
-Peter Senge, Author The Fifth Discipline