Another election cycle finds me fairly gagging on the politician's appeal for health care reform. Democrats want single payor guaranteed and Republicans want to free the market. None of them are serious. They treat us all like fools. We are, actually, when all is said and done. We do not hold them in enough contempt. We do not demand a better way.

    A while back I attended an "End of Lifecare" symposium sponsored by the Minnesota Department of Health when Jan Malcomb was the Commissioner of Health for Governor Ventura. You remember him perhaps, as the guy who said his administration would be different. In many respects it was. In important ones it was not.

    At one of these sessions a prominent leader, an executive of a very good hospital, remarked that she worried sometimes about the public's learning too much about how poorly they were doing. She said she visualized being strung up by an angry mob. She was not looking for laughs. 

    Then that same morning in small group breakout sessions we discussed how to get some things accomplished with respect to end of lifecare issues. The term "thinking outside the box" was often heard. Conversationally these best and brightest were eloquent, impassioned, dare I say bold. But it was all wind, gas, it so quickly dissipated into thin air.  My followups about outcomes, specifically bedsore outcomes were ignored.
Behind the gaze one suspected some measure of fear and an acknowledgement that someone was calling them out, reminding them about their earlier zealousness with respect to necessary reforms. They did not want to do, or risk anything. So what does thinking outside the box get us but a catered lunch, and a very fine lunch it was too.

    The papers in Minnesota are full of the news that Dr. McGuire is stepping down from United Healthcare. He had to back date some options so that his cash could break the billion dollar barrier. A darling of wall street, an innovator par excellence and so far removed from reality one just looses hope that anyone matters anymore. We are on a declining glideslope in health care. Cash generation, names and reputation, data crunched and packaged for the slugs in the public, you and me, to swill. 

    Consider the bedsore. If they exist in any numbers, something directly proportional can be known about the facility and the quality of care delivered. A small incidence/prevalence of bedsores signifies good quality of care delivered. The greater the number of bedsores the poorer the quality. Treating existing bedsores is very costly but conventional medical wisdom states that this is the very best that we can do. They are inevitable, don't you see, all these titans and insiders say. They are wrong.

    Establish no bedsores as the desired outcome, absolute prevention, then sit back and watch a breathtaking result unfold. Health care costs will decline as quality of care delivered improves: a quantum paradox. It can be done. But it takes men and women with chests to do it. These sadly are nearing extinction. The hollow men abound. They are paid very well for these hollow characteristics. We enable them. We are in awe of them. They deserve much less than that.