The dilemma with healthcare reform partly stems from our unwillingness to throw our neighbors to the wolves. Source: Selling Among Wolves.
The good news this week is the trend in healthcare reform. It looks like the U.S. Legislature is once again finding itself incapable of passing meaningful healthcare-reform legislation. If this trend continues, what we'll be left with sometime next year is legislation that makes just enough change to allow the President and Congress to claim a victory, but not enough to make any real difference. This is not surprising, since it's been the same story for every major effort taken up by the current crop of Senators and Representatives.
It's good news because it means the Federal Government will at least do no harm. Or, at least no harm that can't easily be undone in the future.
We actually can't fault Congress for failing in fact, even if they find a way to succeed in headlines. There's a basic flaw in our health care system that can't be fixed. It's actually a flaw in the philosophical underpinnings of our society: we are incapable of applying the 95/5 rule from systems engineering to many of our social problems. We're seeing it in healthcare simply because that's the part of our social infrastructure that has most obviously run into a brick wall.
The 95/5 rule, like many systems engineering principles, sounds precise and quantitative, but isn't. It belongs in the realm of fuzzy logic, which only a few academics, and practically nobody else, understands. Unfortunately, nearly all decisions human beings are asked to make must be made using fuzzy logic. Fortunately, the ability to do fuzzy-logic analysis accurately and at blinding speed is one of the human brain's greatest strengths. Even better, the recognition of both fuzzy logic's importance and humans' aptitude for it is growing rapidly.
The 95/5 rule is just one expression of the fuzzy proposition that, as progress is made in any cumulative effort, gains become ever more difficult to achieve. (To the fuzzy-logic mavens out there: I know I've not couched this proposition in any rigorous way, but to do so would require a lot of verbiage that only you and I would want to read. Everyone else would go away, and thus miss out on today's exciting episode.)
The rule is an extreme version of the more familiar 80/20 rule, which says that 80% of the effort must be expended to achieve the last 20% of the gain. Conversely, the first 20% of the effort generally achieves 80% of the gain. Stated more generally, and more accurately, the effort needed to make further gains increases roughly exponentially with the gains already made. More fuzzily: you reach a point of diminishing returns.
Use the 95/5 rule when you've already blown past the 80% level. The next stop, of course, is the 99/1 rule that says you'll need 99% of the already-expended effort to get the next 1% gain. We try not to go there.
How this applies to healthcare is the simple statement that the easy gains have already been made. The reason healthcare costs are rising so rapidly is that we are now trying to push healthcare well past the point of diminishing returns. The Quixotic goal is highlighted by Pres. Obama's stated goal of providing health insurance for every dang American regardless of their ability to walk through the woods without bumping into trees.
Basically, we're trying to keep medical progress moving along a linear track. Ergo, the cost is rising exponentially.
In a misguided attempt to "fix the problem," most of us have, instead, tried to fix the blame on a boogeyman: the health insurance system. The theory seems to be that, if we can come up with a clever enough formula for health insurance, the cost of healthcare will take care of itself. This seems to be the tack Congress is taking, and, thank God, it isn't working. The cost of healthcare is taking care of itself, alright; it's expanding to take over the Universe!
In future blog entries, I hope to take a look at why medical progress is hitting a wall, and why we're fundamentally unable to deal with the situation. By way of a preview:
Medical progress is hitting a wall because most of the medical conditions that killed off our ancestors have already been eradicated. That was the easy stuff - requiring only a half dozen millennia to complete. Now, all we have to do is the hard stuff.
Human society can't deal with the problem because our basic moral and ethical assumptions don't allow us to throw our fellow human beings to the wolves.
To be sure, I do not have an answer. Like almost everyone else on the planet, I'm not ready to walk up to another human being, whether a loved one or stranger, look them in the eye, and say: "You're too old/sick/feeble/whatever to live. Go die!"
I know a lot of people willing to consider it as a philosophical exercise, but not-a-one who could bring themselves to do it in fact. Well, except maybe some inmates of institutions for the criminally insane.
Therein lies our dilemma.
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