Wednesday, August 20, 2008

The Psychopathology of Healthcare Reform

It seems the healthcare debate has recently fallen off the political map:
The continual tussle between the two presumptive presidential nominees — Obama and McCain — has largely centered recently on national security and the high price of gasoline. Public opinion polls have shown that among the top issues of concern to Americans, health care is languishing far behind the economy, the war and the price of gas. One CBS poll from July put voter interest in health care at just 3 percent. In August, it was at 8 percent.
Is this such a surprise? Gas prices are easy to understand. But start talking deductibles, copays, income deductions to pay for a new public plan or making patients choose an insurance plan with tons of fine print, it's no wonder no one wants to stay focused on healthcare. Hell, it's just too messy! It's a whole helluva lot easier to understand if 70 bucks is in your pocket to fill up your gas tank.

Americans are like that. And politicians and policy makers know it.

So the politicians and policy makers read their tea leaves and go with what's hot at the moment.

And we ignore it.

In the same way that we have not really begun a "national conversation about race," we have not had a "national discussion about healthcare." It's just too emotional, personal and too politically charged. So we should ask ourselves if we, in fact, choose to "believe" in electing politicians who pitch complicated healthcare policy to us as if it were a peaceful bedtime story.

The American soul has been described aptly by one author as full of contradictions:
Americans carry a simultaneous embrace of holiness and hedonism, while pining for the love of tradition as we carry on our headlong romantic affair with progress, (and) as our extreme individualism courses beside a gigantic, gaping yearning for community.
Perhaps because of this American psychological personality, we will choose to believe in someone who will save us from our contradictions.

This is why we can see the new “evidence-based design” architecture for our radiation treatment rooms and cancer treatment centers, along with multi-million-dollar hospital additions full of "woo" promising complete “wellness” whose “extra expense isn’t passed along to patients.” Just like we can see and expansion of healthcare coverage for young adults that will be free, too!

And yet, can we really afford to ignore the debate?

But we do.

Our American psychopathology gets the best of us.

Americans fervently believe in "health care for everyone." We also fervently believe in the truth of government corruption and inefficacy and the truth of corporate self-interest. Most of the time, we're not too crazy about leaving kitchen-table decisions to the Big Boys in Washington. We believe the homeless person should get the million-dollar cancer treatment and we also believe Aunt Molly should be able to get the best health care possible because she's earned it. We believe lots of things. All of these are on the table right now as we continue to gorge ourselves silly with the latest technologies, unfettered hospital construction projects, and limitless end-of-life care.

We have not had a serious national conversation. And if we buy a salesman's pitch on healthcare without dealing honestly with our own psychosocial contradictions, the morning after will not be pretty.

Or it will be pretty, but only for bureaucrats, politicians, and corporate healthcare interests.



Anonymous said...

Hey Dr. Wes -- you make many good points about the need for healthcare reform, but don't pick on evidence-based design until you really understand what it is. EBD is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. It is not about making things pretty or spending money on a whim. Granted, EBD is an emerging science, but more than 1,200 studies exist that link the design of the built environment to outcomes. And, many of those outcomes -- like reduced staff turnover, reduced patient falls, reduced medical errors -- do actually save hospitals money and result in improved patient care. Check out The Center for Health Design's blog on the topic:

DrWes said...


Thanks for the info, and while I do not argue that EBD is nice for patients, can we really expect that a nice pretty ceiling above a radiation therapy machine will improve their outcomes and prevent falls? How exactly does a ceiling do that? Maybe lighting might be improved, I guess, but hey, wouldn't a couple more litebulbs do the same thing? Certainly, such design might improve the patient's sense of wellbeing (and this is a good thing), but real improvement of treatment outcomes in terms of tumor shrinkage or effectiveness of the radiation? I'd love to see the data.

The pseudoscience invading our academic centers is extensively covered over at Respectful Insolence, so I'll return the favor and ask you to be aware of the opposing viewpoint to your argument.

Your perspective contributes exactly to my point - that each of us has to decide if this added expense and lavishness is what we insist upon at a time when many cannot afford the expense of therapy or tests in the first place. No doubt the CEO's like the improved staff retention, but like it or not and despite what your industry marketers would like us to believe, it's still the patients and those of us paying the healthcare tab that are the ones footing the bill...