Teamwork aspects of high costs of US healthcare

Today's New York Times has an editorial on the high cost of healthcare in the USA. There are some parts of that related to teamwork, collaboration, and individualism that I'd like to highlight. Here are a few relevant sections:

Health care costs are far higher in the United States than in any other advanced nation...

It is the worst long-term fiscal crisis facing the nation, and it demands a solution, but finding one will not be easy or palatable....

Doctors in high-cost areas use hospitals, costly technology and platoons of consulting physicians a lot more often than doctors in low-cost areas, yet their patients, on average, fare no better. There are hints that they may even do worse because they pick up infections in the hospital and because having a horde of doctors can mean no one is in charge.

Prevention. Everyone seems to be hoping that preventive medicine — like weight control, exercise, better nutrition, smoking cessation, regular checkups, aggressive screening and judicious use of drugs to reduce risks — will not only improve health but also lower costs in the long run. Preventive medicine actually costs money — somebody has to spend time counseling patients and screening them for disease — and it is not clear how soon, or even whether, substantial savings will show up. Still, the effort has to be made.

Emphasize Primary Care. In a health system as uncoordinated as ours, many experts believe we could get better health results, possibly for less cost, if we ... produce more primary care doctors a.... It would be a long-term project.

The “consumer-directed health care” movement calls for providing people with enough information about doctors and treatments so that they can make wise decisions.

Moreover, few consumers have the competence or knowledge to second-guess a doctor’s recommendations.

[it] should be clear that there is no silver bullet to restrain soaring health care costs. A wide range of contributing factors needs to be tackled simultaneously, with no guarantee they will have a substantial impact any time soon.... So we need to get cracking on a range of solutions.

Oh, where to begin. After two years in the MPH program at Johns Hopkins considering the root causes of these issues, I certainly have a few comments.

First, any way you cut the numbers, the single biggest cost in the US is lack of prevention. Whether machines or humans, it is far easier and cheaper to treat something earlier than later, and it is cheapest of all to never have to treat it at all.

The Toyota philosophy of "lean" emphasizes that the best way to optimize many activities is with an axe. That is, don't spend a great deal of effort perfecting work-arounds when you can prevent the problem in the first place.

However, prevention starts far sooner than "screening for disease" which seems to be the mental model of the Times editors. Prevention means, duh, preventing disease. Not starting smoking in the first place is way cheaper than any "optimized" lung-cancer care, even streamlined with the latest and greatest IT systems and "single-payer" insurance, or whatever.

By any rational accounting, "prevention" is the most cost-effective way to lower health care costs. The issues come a step earlier in tracking back to why efforts at prevention are so strongly resisted, and by whom.

One obvious huge problem is the hedonistic, short-sighted, culture of irresponsibility that is so popular in the US, and reinforced by tens of billions of dollars in advertising expenditures by tobacco, fast-food, and consumer-goods companies, greased by banks and credit card companies and a national philosophy that going massively into debt to buy pretty stuff you want now is just fine, and that debt or physical health problems are something we can deal with "tomorrow", or take a pill for, or just declare bankruptcy for and be done with.

There is magical thinking that we can abuse ourselves or each other with impunity, because we can just go these very high priced doctors and they will fix whatever is wrong. To be honest, large fractions of the drug and medical community's ads tend to propagate that view. "Do what ever you want and take a pill in the morning and you'll be fine" is the message so many people desperately want to hear.

Actual mature, responsible management of the future requires taking some pains and costs today in order to head off much larger pains and costs down the road. This seems to be where most people want to stop listening and stop that line of reasoning.

Why is that? The simple but inconvenient truth is that no "solution" will fix the costs of a larger system in which everyone insists on acting like spoiled children. In T.S. Eliot's words, we are "dreaming of a system in which no one needs to be good" and there aren't such systems. The nation as a whole, and most of its citizens are in massive denial that the debt they're running up against their bodies and our nation will ever actually have to be paid. There will always be a new credit card offer in the mail offering even better low-low initial monthly payments, to keep this afloat another few months while letting the problems fester and grow even worse and harder to repair.

But, keep on with the Toyota's "Five whys." Why is it that the population of the US seems to have gone into a mesmerized trance of depression and denial and inability to cope with predictable, normal demands of adult life? Why is it that a modest amount of self-denial, self-discipline, self-control, and investment in the future is such a scarce commodity in the USA? What's behind this apparent epidemic of infantalism, and the downstream results of chronic and acute diseases and disorders that cost so much even to maintain, let alone fix?

The core component looks like a self-centered, short-sighted selfish view of everything, latched down with a corresponding cynicism and effective behavior as if no one expects tomorrow to ever actually come, so we should just party today and toss all caution to the wind and have fun.

Unless that is changed, the bill for damages will continue to grow without bounds, and no readjustment of insurance payment schemes or national medical records will be enough to stop the incoming tide.

What's all this have to do with my title, namely "teamwork"?

The point is that this multi-level living thing, the USA, seems to have fallen collectively and individually into a state of depression and despair, with a corresponding inability to cope with activities of daily living, masked by drugs, alcohol, and frenetic entertainment.

And that is a "public health" problem. We have somewhat literally fallen and can't get back up, and individuals who could get up and being swept back down by the undertow from the larger culture that has abandoned restraint, with sub-sectors of the corporate world as well that are running amok, destroying their host as it were, killing off the population and the economy that they count on to survive over time. And, lately, possibly, killing off the entire planet's climate and biosphere.

This is not healthy behavior for adults. Something is seriously wrong.

But, what something?

The "something" in my view is that we have rejected the concept of our own social existence, and glorified "the individual" to the point where we have pillaged or discarded the social capital that we need to make this complex system operate and carry the load we present to it.

We've glorified the "now, here, me" trio to the point of destroying everything else trying to make "now,here, me" stronger, and not realized that this is a losing strategy, because the factors that make "me" strong are precisely those social concerns that we mistakenly thought were extra baggage.

We've forgotten the interaction term.

We worship the idea that great individuals built and run the country and our corporations, and blipped the idea that great interacting teams are actually what did all that.

But the "self-energy" of this billiard-ball model turns out to be far less than what we need to keep the country afloat. It was our concern and compassion for each other that was the active agency that built our communities and country. Despite many wars and much violence, for the most part we evolved to this point seeing each other as resources to help us cope with a hostile external world, and therefore being willing to invest in each other.

Maybe it was massive urbanization that led to us viewing each other as competition for external resources, that "we" have to grab before "they" do.

In computer algorithm terms, "N" people have something like at least N-squared interactions that we need to manage, but if we fragment and try to each deal with this separately, we have at most a power of N, which is way less than N-times-N. It doesn't matter much more if most of the N are busy having fun, expecting the remaining fraction to run things for them -- the point is that without beneficial interactions getting our solution power up to N-squared or larger, our weight exceeds our buoyancy, and we will continue to sink.

No resource sharing arrangement or IT system or single-payer mechanism or other "system" will solve that root-cause problem.

We need to transition to seeing each other as resources, as part of the solution not as part of the problem, or we will have created a self-fulfilling expectation that will continue to spiral down.

And that is true for cells, for people, for teams, for companies, for nations, and for cultures.

We're in one lifeboat, and, basically, either we all make it or we all drown. Fighting to throw everyone out of the boat besides ourselves won't work, because there's not enough of us to row or know where to row to.

So, we're going to have to learn how to make it palatable and acceptable to turn to each other for support and help and psychological support to overcome this legacy of mutually destructive self-centeredness. We have to "learn to be good."

Sometimes I get the impression that the rich and powerful think that it would be a great world if just all the poor people would die off, sort of like Jack Welch must perceive that GE would be even greater if only he could get rid of the burden of all those employees. These are easy misperceptions if you don't grasp how the multi-level world masks the other levels from burdening your perceptions, but they are dangerous myths that can lead to neglecting caring for the people who hold everything together.

If the body dies, it takes the brain with it.

If the body is sick, the mind cannot be well.

Parochialism and fragmentation at this point are the road to disaster. We need massive multi-level integration and collaboration across diversity to hold this beast we have created here together in the coming white water.