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Does healthcare need a manager (A), a leader (B), or a dictator (C)?

Posted Mar 02 2010 10:27am

The answer to the title question is (B) with a little (A), but all we seem to get is (C).

A manager handles (“manages”) what is. A good manager optimizes what we have today, what we have now.

A leader moves us into the future, from what is to what will be. A semi-serious definition of a great leader is one who tells us that we are going the hell and we look forward to the trip. An effective leader has people willing and eager to follow.

A dictator also has followers, reluctant ones who follow through coercion. A dictator tells you what to think, what is correct, what to do, and what will happen to you if you do not follow. Lately on healthcare, our President has been more dictator than either manager or leader.

What is truly wrong with healthcare cannot be fixed from above. No one can dictate principles or tell us what to think, certainly not in a democracy and most particularly not to Americans.

Think back to 1993 and Hillary Clinton’s plan for healthcare. It was a ‘fix’ imposed from Washington. We did not tolerate that approach then and will not tolerate it now.

Think back further, to the founding of our nation. The Bill of Rights is the glue that has kept us together for over 230 years. Without a general consensus on principles, we could never have weathered the abolition of slavery, HUAC, or Vietnam: they would have torn us apart.

Healthcare is as contentious as slavery or freedom of speech. The fact that there is no agreement on basic principles makes it impossible to construct a system that will work.

Is health care a right? Should there be personal responsibility in health care? How should bad outcomes be handled? What role if any should the market play? Someone or something will ration healthcare: who should do it?

These are not simply interesting academic question. They govern how the system operates. The fact that there is no consensus means that the system exists without a rudder. Whoever has the loudest voice gets what he or she wants and the answers offered for this sick patient (healthcare) are political compromises rather than medical cures.

Without agreed-upon principles we have • A system that is both market-driven and highly regulated at the same time.
• A tort-based medical malpractice system that actually prevents learning.
• The world depends on new antibiotics, Lipitor, HIV medicines, etc. that a highly innovative U.S. drug industry creates, yet big pharma seems to be everyone’s favorite villain.
If this sounds confusing, contradictory and unstable, it is.

President Obama said in his 2010 State of the Union speech, “If there are alternative ideas out there [on healthcare], I want to hear them.”

Here is one: Start practicing good medicine on healthcare. Be a leader, and lead a national dialogue on healthcare principles.

Over time, this will create a consensus on what the system is and is not. Yes, there will initially be distrust, anger, invective, and blaming. We need to go through Kubler-Ross’ stages of death and dying because we are talking about the death of the old system. Through creative destruction, we can begin to develop a system that actually works: affordable, high quality, constantly improving, and an example for the rest of the world.

Mr. President: If you are a man of your word, you will become a great leader and help US create a workable, American healthcare system to replace the “broken” one we have now.

System MD

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