Is this the best that we can do?
Those who purport to be in charge of provider and payer organizations, in both the private and public sectors, clearly don't ask this seminal question often enough. Let's take the recent surge in Medicaid enrollment facilitated by the ACA as the first example. While it's certainly a good thing that folks who until now were denied access to insurance finally have it, is that truly the best we can do? It's not that Medicaid is a bad health plan, quite the contrary, but it was designed as a safety net for those who were out of jobs or down on their luck. It wasn't designed to be a permanent health plan for a whole swath of the citizenry, and it shouldn't. The next and far more tragic example, especially on this remembrance day of the Normandy landing, is the death of veterans, not at the hands of a foreign enemy, but at the hands of a health system that was designed to heal them from the wounds of war. Certainly that's not even close to the best we can do, but how could it have even been allowed to happen? The answer, to an extent, lies in a chapter of The Incentive Cure: It's hard to be good when you're encouraged to be bad…or even evil.
What this means to you – the combination of business as usual inertia, unwillingness to hold people in charge truly accountable for their actions or lack thereof, and oftentimes a simple lack of just plainly saying: No, this is not the best we can do, have all led us down these broken paths. There's obviously a tradeoff between perfection and good, but in so many instances we're so far away from good, that we can keep asking for better for quite some time. Safer care in the face of unjustifiable deaths, whether due to excessive wait times leading to the underuse of needed services, or errors from the misuse or overuse of services, should be a right, not a privilege. Veterans certainly deserve a lot better given their own sacrifice for the country, but ordinary citizens deserve better as well. And this isn't about lofty politicians' empty promises, but rather about insisting on the basics of public transparency and accountability. Whenever we turn a blind eye or find an excuse for keeping the status quo, we're individually and collectively contributing to the problem. For that, the solution is easy. Every morning, when you look at yourself in the mirror, simply ask these questions: Is this the best I can do? Is this the best that those whose services I pay for can do? Is this the best that those who are in charge can do? And for whomever the answer is no, make a change, because compromise is the slippery slope that has led us to where we are today.