A Bedtime Story
Let's say that policymakers decided it was time to do something about what they perceive to be the poor performance of hospitals run by cities and municipalities. Now, these policymakers are not medical professionals, they don't work in hospitals or have a clue what happens in hospitals, but they apparently stayed in a Holiday Inn Express recently which endowed them with sufficient expertise that whatever policies they put in place can be considered great even absent medical training or input. They create a set of goals, again, no need for input from medical folks, that don’t actually signal effectiveness and draw lots of lines in the sand as to where they’d like hospitals to be without understanding what either the metrics do or if the lines in the sand mean anything. They then assign label to those lines so it will be clear who is and is not failing within their excellent system that they do not understand and that does not mean what they think.
They run with those very policies for twenty or so years, all the while watching hospitals fall short of the goals they as non-medical experts expertly established, complaining at every step of the way because hospitals can't seem to meet the goals that do not mean what they think they mean. The goals and the policies being correct (Holiday Inn Express, remember) means that the only thing to blame are the doctors and nurses and administrators. The consensus? The local medical system is broken and needs a kick in the ass through competition. They create a parallel system of hospitals funded by the state that can compete with those locally run hospitals and teach the locals a lesson by taking money away from them and giving it to the new and different system until the old hospitals are willing to get better. And of course, they’ll want to encourage creativity in their new hospital system, which they never encouraged in the old one, but that’s beside the point. And then they’ll want to ratchet up the goals for the old system that don’t mean what they think they do so it will be easier to get even madder at the local hospitals going forward. Oh, and remove most of those goals for their new and exciting system, but that it beside the point.
They do that for another twenty years. Hospitals are still falling short of those very excellent goals policy makers still don’t understand and don’t have anything to do with hospital effectiveness, which is unfathomable in the face of those stunningly great policies that have changed almost not at all in forty year, so it must be that the public system of hospitals is fundamentally and irretrievably broken and needs far more than a kick in the ass. The answer: private hospitals that are super expensive and entirely unregulated! That’s the ticket, they say. So now they look at the average of what it costs for a medical procedure, add 30%, and give that much to anyone who wants it so they can go to the private hospital instead. The local hospitals are just wasting that money anyway, so it makes sense to get it out of their bloated coffers and give someone else a try.
“Who really cares that the private hospital fees are two or three times what the city hospitals cost,” they say. “We’ll give people a nice chunk of change and if they really care about their health they’ll make up the rest.” The fact that most of the people who ask for and get the money already go to the private hospital is besides the point. And if they want to spend that money on other things, fine. Not the worry of the policy crew. Everyone now has options and choices other than the terrible public hospitals that have been the beneficiary of forty years of great polices and meaningful goals and objectives and yet still can’t get their act together, and choice is the point of the the thing, right?
And, just to be clear, should some of those hospitals reject patients based on preferences regarding race, religion, gender, or sexual orientation, that’s just the price for helping constituents get out from underneath a terrible system of hospitals, and really, those city hospitals have no one to blame but their pitiful selves. They had every chance and more to get their act together and for forty years chose not to within the great polices and goals established for them by people that have no clue how a hospital works. Those medical nuts are the ones that killed the system, not those very excellent policies and goals inspired all those year ago by a stay at a Holiday Inn Express.
The end.
They run with those very policies for twenty or so years, all the while watching hospitals fall short of the goals they as non-medical experts expertly established, complaining at every step of the way because hospitals can't seem to meet the goals that do not mean what they think they mean. The goals and the policies being correct (Holiday Inn Express, remember) means that the only thing to blame are the doctors and nurses and administrators. The consensus? The local medical system is broken and needs a kick in the ass through competition. They create a parallel system of hospitals funded by the state that can compete with those locally run hospitals and teach the locals a lesson by taking money away from them and giving it to the new and different system until the old hospitals are willing to get better. And of course, they’ll want to encourage creativity in their new hospital system, which they never encouraged in the old one, but that’s beside the point. And then they’ll want to ratchet up the goals for the old system that don’t mean what they think they do so it will be easier to get even madder at the local hospitals going forward. Oh, and remove most of those goals for their new and exciting system, but that it beside the point.
They do that for another twenty years. Hospitals are still falling short of those very excellent goals policy makers still don’t understand and don’t have anything to do with hospital effectiveness, which is unfathomable in the face of those stunningly great policies that have changed almost not at all in forty year, so it must be that the public system of hospitals is fundamentally and irretrievably broken and needs far more than a kick in the ass. The answer: private hospitals that are super expensive and entirely unregulated! That’s the ticket, they say. So now they look at the average of what it costs for a medical procedure, add 30%, and give that much to anyone who wants it so they can go to the private hospital instead. The local hospitals are just wasting that money anyway, so it makes sense to get it out of their bloated coffers and give someone else a try.
“Who really cares that the private hospital fees are two or three times what the city hospitals cost,” they say. “We’ll give people a nice chunk of change and if they really care about their health they’ll make up the rest.” The fact that most of the people who ask for and get the money already go to the private hospital is besides the point. And if they want to spend that money on other things, fine. Not the worry of the policy crew. Everyone now has options and choices other than the terrible public hospitals that have been the beneficiary of forty years of great polices and meaningful goals and objectives and yet still can’t get their act together, and choice is the point of the the thing, right?
And, just to be clear, should some of those hospitals reject patients based on preferences regarding race, religion, gender, or sexual orientation, that’s just the price for helping constituents get out from underneath a terrible system of hospitals, and really, those city hospitals have no one to blame but their pitiful selves. They had every chance and more to get their act together and for forty years chose not to within the great polices and goals established for them by people that have no clue how a hospital works. Those medical nuts are the ones that killed the system, not those very excellent policies and goals inspired all those year ago by a stay at a Holiday Inn Express.
The end.
Great analogy, John. Until professional educators are viewed in the same light as physicians, they will be the target of blame for this country's woes.
ReplyDelete