Lessons from Timothy Treadwell for Healthcare Reform

Timothy Treadwell had his own vision of the world, particularly in regard to wild bears.  An example of that vision can be seen in a video of Treadwell, sitting in a stream, reading to a bear he had come to know.

Few question the sincerity of Treadwell, also known as the Grizzly Man; he loved the out of doors, all its wildlife, and he surely loved bears. For over 13 years he followed them, filmed them, wrote about them, and as much as he could, lived among them.  On Monday, October 6, 2003 the partial remains of Treadwell were discovered, he had been eaten by the bears.

I’m not making light of Treadwell or his cause; still this tragic little story was, inevitable.  Treadwell’s vision of the world dramatically differed from reality, and in the end, reality prevailed.  He couldn’t help himself in wanting to be closer and closer to the bears he loved, and slowly over time, he extended that vision to his own peril and that is the lesson.

This is a great example of where we find ourselves in the healthcare reform debate.  It’s very comforting to think that there is a group of people, so smart and insightful as to be able to craft a plan to manage the healthcare of millions.   We are, it seems, eager to abandon the evidence of our senses and believe that by some means not fully understood, a group of ordinary people who, having chosen to work for  the government, will have morphed into something they previously were not.  These individuals will somehow craft a workable healthcare system in a way no one has ever considered in the past.  Within this system, diversity goals will have been met, procedures will be reduce, screening will go up, more people will be treated, innovation will thrive and costs fall.

I don’t question the sincerity, but outcomes are not bound to sincerity or good intentions, they are bound by actions; not what people think or wish, but by what people do. It is noteworthy that the end for Timothy Treadwell was also the end for his girlfriend (also eaten) and for the two bears suspected to have done the deed.  All are gone.  It seems that this congress is committed to a vision of the world around them, wholly unsupported by history or evidence, and that we the will have to suffer its consequences; how very sad and exceptionally unnecessary.

Thomas A. Coss, RN

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October 31, 2009 | Tom | No Comments »

A Case for Truth and Plain Speaking in Healthcare Reform

Suppose that a physician who is treating you for cancer, were to observed the same scruples regarding their use of language as we currently see from President Obama, and congressional leadership. Now lets say that this same physician were to tell you that your “cancer is cured”.  How would you know if you should start that James Mitchner novel you’ve wanted to read, or dial 911?

Medicine, for all its flaws and inefficiencies, has an exceptionally high regard for truth and plain speaking.  You would not find a physician willing to tell you “you’ll be fine” when he or she believes by knowledge and experience, that you will not; to do otherwise would be considered malpractice. Physicians may choose their time and place, but you’ll not find them mincing words when it counts.

If the president and congress is going to mess with healthcare, they need do so by the rules of medicine, not politics. They need to investigate and understand the problem completely, and then produce a clear, accurate and defensible diagnosis.  They need to share that diagnosis with the patient and family ( in this case the entire US citizenry) discuss options, and define anticipated outcomes of each one.  They need to answer all our questions, even if we repeat a few, and provide us the evidence they have in support of their diagnosis and treatment plan. And finally, nobody should be doing anything without our written permission.

We should not accept anything less out of the president and congress than we would of our Doctor.

Thomas A. Coss, RN

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October 15, 2009 | Tom | No Comments »

Repricing in America

I’ve been bothered in the best possible way by a comment made by Richard Davis, President and Chief Executive Officer of U.S. Bancorp. In almost a throw away fashion Richard told an audience of business executives in Orange County California, that the economy is going through a process of “repricing ” downward.

Clearly we know this to be the case in the housing industry, as those of us with houses have seen about 25% or more of the assessed value of the house disappear.  As troublesome as this has been for many people, it has not stopped there.  Just look around and you’re seeing it in the automotive business, grocery stores, and restaurants offering significant discounts. In the labor market, those getting new jobs are doing so at often dramatically lower salaries.  Everything it seems is ratcheting down, finding a new market clearing level.

This deflation, or to be more positive, repricing, has consequences which favor highly efficient, low fixed overhead companies over those with large superstructures of bureaucracies.  As we’ve seen, some companies can relieve some pressure by laying off labor, but those companies (I’m thinking GM) with lots of large buildings and large fixed expenses, can’t adjust sufficiently and quickly enough.  For these large companies, it is exceptionally difficult to accommodate to downward price adjustments, hence they fail.

Companies which do succeed in these environments are new ones.  These companies benefit by being new and not around so long as to have large fixed expenses, these are the entrepreneurs.  The best way to grow our economy is for the US to have a brisk entrepreneurial bias in its policy decisions.   In this Economy, as serial entrepreneur Ken Forbes, CEO of AppointYou in Aliso Viejo, California told me, it is easier to create a job than get one.  This is the best time for the creative among us to leverage their comparative advantage of being lean, to get their products and services into the economy and make wonderful things happen for us all.

Thomas A. Coss

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October 3, 2009 | Tom | No Comments »