A Massachusetts Surgeon Weighs in on the Meaning of Scott Brown’s Senate Victory: Post 81
Warning to readers: This post, like a previous post, Gotcha: A surgeon dissects patient-centered care, contains more rant than reason. Those who feel passionately that Congress is doing a great job dealing with the people’s healthcare should look elsewhere for confirmation of their views.
In An Interview with Stuart Altman, this distinguished healthcare economist mentioned Altman’s Law, that advocacy groups seek to preserve the status quo rather than adopt another plan that might disadvantage their interests.
January 21, 2010, in Citizens United v. Federal Election Commission, the Supreme Court voted 5-4 to remove limits on contributions from corporations and unions for “electioneering communication.” Hailed by some as a victory for the First Amendment right of free speech, to at least one skeptical surgeon, it means that free speech just became more expensive, as limitless contributions pour in to influence 535 votes.
Kudos to David Harlow for getting it right in his commentary, Holy Mackarel: Scott Brown, Health Reform Redux and What Can (Should) Happen Next: “it is time to think about other avenues towards the improvement of the health care system in this country.” Reform efforts will go on while Congress is embroiled in partisan gridlock. As David mentioned, states have become the learning laboratories.
Medicare demonstration grants in Colorado, New Mexico, Oklahoma, and Texas continue to investigate the merits of value-based purchasing of healthcare services. Patient-centered medical home projects, as described in Engaging Physicians to Adopt Healthcare Information Technology, represent a continuous, proactive, consumer-directed approach to care coordination.
In My Inadvertent Oncology Fellowship: Why I Remain Optimistic About Healthcare, I concurred with fellow Massachusetts surgeon Dr. Atul Gawande, that healthcare reform embodies an iterative journey, where we test different hypotheses in our learning laboratories, because no one has sufficient knowledge to assert that one way of delivering care will work for all our citizens. Dr. Gawande concluded in Testing, Testing:
But if we’re willing to accept an arduous, messy, and continuous process, we can come to grips with a problem even of this immensity. We’ve done it before.
As I mentioned in “Embracing Complexity,” in Better Communication For Better Care: Mastering Physician-Administrator Collaboration, face-face conversations are the only sustainable way that people can deal with complex situations in which predictability is diminished, experience does not guarantee success, and relationships are key.
Complexity facilitates interest group politics, as members on all sides struggle to convey their message in 30 seconds or less. In Collaborative Sensemaking, I described the critical role that healthcare leaders must play in interpreting and explaining disruptive marketplace changes and framing what is required for successful healthcare delivery.
Finally, I thank my mentor, Lee Kaiser, who in Collaborative Gnosticism, wrote:
Most people and most organizations see themselves at the center of the universe, which leads to egocentric, self-interested approaches that facilitate exploiting others for competitive advantage, hardly a sustainable approach to differentiation and the service of others… There is no economic, social, or political solution to the current healthcare crisis. Spirituality, based on abundance, collaboration, and sharing provides the only solution because it makes problems disappear.
As always, I welcome your input to improve healthcare collaboration, even if sometimes I feel (to paraphrase Churchill) that we embrace it only after we have exhausted all other alternatives.
Kenneth H. Cohn
© 2010, all rights reserved
Disclosure:
I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein. David Harlow is a friend, colleague, and coauthor with me of Field-tested Strategies for Physician Recruitment and Contracting. Please check out his HealthBlawg.
Posted in WaterCooler Collaboration
Comments
Comment from Ken –
Thanks for agreeing with me!
Pelosi is paraphrasing Churchill this week too: “We’ll go through the gate. If the gate is closed, we’ll go over the fence. If the fence is too high, we’ll pole vault in. If that doesn’t work, we’ll parachute in. But we’re going to get healthcare reform passed for the American people.” Not sure when the grim reality will set in.
Comment from Thanks David,
Over the weekend, I participated in an insightful forum chaired by Dr. Taylor Dickinson, entitled “The Physician as Solution.”
It was encouraging to meet kindred spirits from all over the US who shared our views.
Time: February 15, 2010, 3:26 pm
[...] A Massachusetts Surgeon Weighs in on the Meaning of Scott Brown’s Senate Victory: Post 81 [...]
Time: April 22, 2010, 8:39 pm
[...] was wrong. I wrote that Scott Brown’s victory in the Senate election in Massachusetts meant that we needed to pursue other areas of healthcare [...]
Time: May 23, 2011, 7:36 pm
[...] innovations that may not work initially like value-based purchasing, telemedicine consulting, and remote monitoring (eg.weight for heart failure [...]
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