Updated: Nov 6, 2020
We must be willing to examine the fundamentals of health care in the US.
Status quo thinking accepts “the way things are” as the way things ought to be or as the starting point for improvements. An example of status quo thinking in health care is that including more and more services as covered services is a good policy goal, simply because today we tend to use insurance as the financing mechanism for most everything. However, this ignores fundamentals of insurance and has many negative unintended consequences. It is status quo thinking in the sense that it assumes the way our system is set up today is good and should continue; it says that this approach does not need to be examined. Status quo thinking assumes that we are powerless to affect the way things are today so we shouldn’t even try, or alternatively, it assumes that decisions that have been made in the past are the best possible decisions and nothing from the past should be reexamined. At Descant, we reject that we are powerless and we reject that all past decisions were for the best. Status quo thinking is anathema to critical thinking and high quality scholarship; it is often an obstacle to improvement because it ignores fundamental questions about how things are already set up.
Another reason Descant focuses on challenging status quo thinking in health care is that our system is very inefficient and dysfunctional. Status quo thinking may accept the inefficiencies and dysfunctions as part of accepting what is. We don’t believe that fiddling in the margins will get us much improvement; rather, we want to fix the fundamental problems causing the inefficiencies and dysfunctions and the first step is acknowledging and examining how our health care system is set up. We can’t do that if we accept what is as a starting point for improvement. We are not content with tweaking things in the margins because health care and health are way too important for everyone.
We must face the reality that health care is a limited commodity. As with any other good or service, there is a limit on how much can be supplied and our needs and wants cannot be fully satisfied. Trade-offs must be made.
We envision a health care system that encompasses the best of what is great and strong and efficient about other sectors of the US economy. In such a health care system, patients are well-served, they have many choices for insurance and health care that suit their needs and preferences. Providers of insurance and health care services are tuned into what patients want and eagerly compete for their business. Prices are rational and transparent, only those middlemen who add commensurate value survive. Innovative mechanisms for assisting patients who have low income or expensive chronic conditions with access to affordable insurance and health care options proliferate, with states playing a key safety net role for these patients. Patients and physicians are reestablished in their central role as the main decision makers, and the doctor-patient relationship is restored. Rather than going along with the conventional wisdom that Medicare is so big that it necessarily will dictate how things work for patients of all ages, we focus on improving the functioning of the health care system for the non-elderly and finding ways to incorporate those improvements into Medicare so that seniors may benefit as well. By fixing the fundamental flaws of our healthcare system, we will spend significantly less than we spend today and have better results, better patient outcomes, better treatment decisions, and better distribution of health care dollars, workforce and facilities where and how they are most needed and valued. Over the longer term, this efficiency and effectiveness of the health care system will save us untold hundreds of millions of dollars on Medicare, Medicaid and other government expenditures related to health care. America’s economic future will be much better, more secure and more sustainable as a result.
Of course, making fundamental changes to even part of the health care system is a huge undertaking and we must face the reality that health care is a limited commodity. As with any other good or service, there is a limit on how much can be supplied and our needs and wants cannot be fully satisfied. Trade-offs must be made. Even so, it is our belief that the best, fairest way to ensure that the largest number of people get their most important needs met is through a system undergirded by free-market mechanisms and supplemented with an efficient and effective safety net. The first step in remaking the health care sector into another high functioning part of the US economy is to challenge status quo notions that support government involvement in all aspects of health care, more services covered by insurance, and layer after layer of bureaucratic rules designed to "help" doctors and patients make decisions about health care.