In a recent article in The New Yorker by Amy Wild, readers are introduced to award winning female architect Jeanne Gang who designed the acclaimed Aqua tower in Chicago . Gang’s specialty is the relationship between nature and culture, which helps explain the article’s deep dive into the issue of captive dolphins and aquarium shows. In the process we’re introduced to Baltimore Aquarium’s new CEO, John Racanelli , who took the helm in 2011 and has contracted with Gang to design a dolphin sanctuary to shelter the organization’s captive dolphins once Gang refashions the existing Marine Mammal Pavilion for other purposes.
In discussing the issue of captive cetaceans, Racanelli and Gang recall meeting at a London based research tour to evaluate European museums sponsored by IMPACTS R&D and it’s American founder Scott Corwon. At that meeting, the issue of captive dolphin shows came up and Corwon opined on the pace of change in public opinion. His research had shown that millennials under age 30 were turning negative to these venues at a much faster rate than older Americans.
Corwon compared what was happening in aquariums to opinions on gay marriage: “It’s changing slowly, it’s changing slowly – it changed. Even very learned people think it’s going to be a glide path. It’s not – it’s going to do what every movement does.”
Plateau, plateau, plateau – blink, change, done, new reality.
I read the article less than 24 hours after attending the Board meeting of the National Alliance for Caregiving in Washington, DC. We were each asked to describe what we were currently working on. I chose to outline a list of disrupters, largely triggered by the Affordable Care Act, which I felt were moving us to the third “plateau”. The message – plan for the new reality, not the old one.
Obamacare is essentially a health insurance reform bill intended to break through the status-quo and trigger major structural reform. It recognizes the huge potential for savings. As Rev. Norman Vincent Peale said many years ago when facing a new professional opportunity, “If given the choice where to go, choose failure over success”, because there is more room to succeed when encountering a failed enterprise than a highly efficient and successful one.
Few would argue, after examining the relative cost and quality performance in our US system to others around the world, there is ample room for success. What may be less obvious is that the Affordable Care Act fully intends to do more with less, and leaves it to patients and their providers to figure out how to make it happen – if not on a state level (as in some red states) then on a federal level. Under these circumstances, innovative and creative thinkers win. That is why Baltimore Aquarium’s Racanelli hired Jeanne Gang.
In the world of health care change, demography trumps geography, mobility trumps brick and mortar, and obstruction and resistance can morph overnight into irrelevance. What signals are we seeing emerge within the health care marketplace that suggest we are at the edge of the old plateau?
1. Physicians are choosing employment over independence in both generalist and specialist fields. This means more cooperative relationships between generalists and specialists; new job descriptions for physicians that better leverage their training and expertise; team leadership roles for those physicians with the inclination and skill; less focus and obsession on fee schedules and more focus on system and population wide performance; and with this, more allegiance to one’s local health system than to national medical trade organizations.
2. Patients now may enjoy the “right” to health care access. But they will soon realize that in return, there will be a sudden ramp up in “responsibilities” individually, as families, and as community. The days of segmenting the multi-generational family, and passing the cost of preventable burdens of disease on to society are coming to an end. If you chose to embrace unhealthy behavior, if you chose to ignore family members in need, if your community is inept in organizing a range of supportive services essential for your success, you’ll pay for it one way or another.
3. Industry now must adjust to a consumer base accustomed to critically examing what they ingest – both food and medicines. “What’s in this?” and “Do I really need to take this?” has supplanted “What ever you say, you’re the doctor.” The bias is now less, not more. Necessity must be proven, especially for chronic meds. There is no more “learned intermediary” or “paid-for expert” to shield the manufacturer from product liability or justify overselling benefits and underselling risk.
4. Legislators and governors are on the time clock now. You don’t want to expand Medicaid – fine. But the price will be steep. And part of that price will be that your citizens will now be serviced out of Washington rather than through your state house.
5. Finally, insurers are engaged. Why? Because if this doesn’t work, the next stop is “Single Payor”.