It's easy to lose the big picture in the throes of birth, and that, I believe is what's happening to health care reform.  I don't usually wax politic but this situation screams out in need. 

As an educator and physician, I believe we desperately need health care reform, though not, perhaps in the way that we're intent on pursuing it.  You see, there are several "big pictures" that have been lost that are absolutely essential for health care reform to really happen.  The first is to realize, as former President George W. Bush unwittingly taught us, that money is an illusion.  People, especially our children, on the other hand are not. 

Business, no matter what area it is applied to is fundamentally flawed by virtue of simply forgetting this basic premise, and this flaw seems to be driving health care reform, blocking virtually every effort to make it do what it needs to do and that's provide accessible, affordable health care to all who live in America. It's not about money. It never was. It can become a money (business) game, replete with business rules regarding incrementally increasing profits, distribution of payments for services rendered to support a huge bureaucratic cadre, and most important of all with the fundamental flaw of business application:  That money justifies whatever it takes to get it. 

In order to fix our nation's health care system, the first thing we need to do is to re-acknowledge that health care is not a business, not a sellable product, not a supply and demand driven entity.  It's a service.  A humanitarian service that we as humans provide other humans because we're human.  It's actually the same in regard to the environment - care of the environment isn't a business problem. It's neither a business, nor does it necessarily generate a sellable product, nor is it supply/demand/profit driven.  At least it shouldn't be.  It's a service.  The same with education.  What is happening to our society is that, in my opinion, we're replacing the church with business. The problem is that business has no ethics - if you disagree, just look at the most visible mentor model in the USA, our former president. It's all become business gone amok. 

The first step to fixing the health care system is to recognize the situation, and that business, which, while not necessarily causing the whole problem, has precipitated it and continue to destroy every effort towards solving the problem.  If money is the great illusion, then the business axiom that collective greed can be channeled into a better good is one of many resulting delusions.  We need to step outside the box on this one (and on the environment and education, too).  But where to start?  Well, if you've gotten this far, you've taken the first step: searching for the big picture.

The second step may seem a return to business, but if you'll humor me a moment, I think it will become clear that's not the case.  We need to stop the business of taxation as we've evolved it, and institute a flax 10% income tax.  There, I've said it.  Now you can cat-call and throw rotten vegetables at me.  But the fact still remains that without a solid monetary base, any effort to develop a health care solution will continue to fall short of being economically feasible without taxation reform, and ultimately end up back in the lap of business.  No, flat taxation of individuals and all that is corporate is absolutely necessary to make it even feasible to consider national health care reform. 

The next step is to remove the bureacracy.  That includes most of our current "health care schemes," like prepaid health care, HMO's, and health insurance and once again recalling that health care is a service by humans to humans.  That's where the health and healing is at.  It's not in the legions of corporate officers, managers, clerks and recordkeepers.  Oh yes, some recordkeeping is absolutely necessary.  But wasn't that what computers were going to do for us?  And what about the growing laboratory, diagnostic and imaging industries?  I attended a National Institution of Health Consensus Conference decades ago and suggested everyone watch Star Trek.  When we can eliminate laboratories, diagnostic facilities and imaging centers and put these instruments back in the hands of the physicians and nurses who need and use them, when the processes no longer require puncturing the skin (most don't really need to and each puncture takes with it the possibility of introducing bacteria directly into the bloodstream), when technology begins to once again serve the servers rather than business, then we will begin to realize our dream.  That's a big change, though, both in philosophy and direction.  It's really not much different in the environment or education, either.  Putting technological tools in the hands of service providers who need them is, I believe, simply good thinking.

Next, the whole notion that hospitals are temples of healing needs to be rethought.  I'd rather have a private-duty nurse, some technology on-call, and stay at a resort next to the ocean when I'm needing healing.  The amazing thing is that it's far less expensive, there's fewer antibiotic resistant bugs waiting to take advantage of a convalescent, and done right, the provision of hospital services through hotels and motels could actually revitalize the industry.  Services at a hotel or motel?  What an interesting concept.  5-star you say?  Then I'll take my surgical recovery there, thank you, if indeed 5-star means human service.  I've never gotten that in a hospital except from the overworked, underpaid nurses, and I'm a doctor, remember!

Some might already be getting their ruff up to say something about how mental health services (are they really services as I've defined service?) actually declined while expenses mounted when decentralization came about forcing the mentally ill onto the streets to catch as catch can.  No, that was a business decision.  It would be nearly the same as saying that immunization, which is usually infinitely more expensive than simply letting people die quickly of the disease, should therefore be stopped for "cost-effectiveness" reasons.  Cost-effectiveness and cost-benefit are business concepts, not service concepts. 

Now it's time to rebegin looking at how to help people really recover their health and stay healthy.  But this blog entry is getting pretty long and I'd like to save that for another time.  The important thing is that we need to recognize that business has it's place, like the church and state, but it's not going to solve the health care crisis.  It's going to take a whole new generation of individuals with a firm re-commitment to humanity, rather than the illusive buck, which may I remind you has no intrinsic feelings or ethics to keep it honest and true.  If you doubt what I'm saying look at the biggest businesses of our era:  the arms industry, the violence and violence product industries, the cigarette industry, the liquor industry.  These are not service industries but purveyors of misery and death for profit. If you don't believe me, just sit in a boardroom meeting when the topic of human misery and death come up - the issue is usually how to keep the government or other regulatory agency from becoming aware of it. 

I don't think business has what it takes to make a humanistic health care system.  I think that is going to take a new kind of people who value life, human and otherwise.  There's plenty of "work" to go around in a service-oriented world, plenty of diversity, trade, need and satisfaction.  If you know where that world is, please point it out to me.  I'd like to join it.

Dr. Daniel S. Janik MD PhD