Original Publish Date: February 7, 2022
“In order to understand the world, one has to turn away from it on occasion.” -- Albert Camus
The Mystic Art of Automobile Racing
On May 23, 2023, for the eightieth time since 1929, the best racers in the world will travel the 3,337 kilometer, 78 lap Circuit de Monaco in Monte Carlo and La Condamine. The pit-lane is the exclusive place where cars change tires, handle possible maintenance issues, and perform final checks before the race begins. The mechanics behind the scenes are experts in the automotive craft, a necessary prerequisite for the individuals who may ultimately direct victory or defeat. Indeed, the Monaco Grand Prix is one of the most prestigious automobile races on Earth, comparable to the Daytona 500, the Indianapolis 500, and the 24 Hours of Le Mans.
If health care existed in the universe of automobile racing, some of its top events would include Mayo Clinic, Cleveland Clinic, Massachusetts General Hospital and The Johns Hopkins Hospital. To be sure, some of the world’s best health care practitioners remain behind the proverbial wheel at these prestigious health care facilities, supported by myriad health care practitioners with varying degrees of licensure and expertise.
A System in Need of Repair
The analogy turns bleak when trying to compare master mechanic Michael Kübler (credited with the Mercedes-AMG C 63 S Coupé), Porsche-trained master mechanic Karl Kainhofer (Roger Penske’s personal race mechanic), or the legendary Ferruccio Lamborghini (Automobili Lamborghini S.p.A.’s creator and master mechanic) with some of health care’s master architects. Whether or not Jonathan Gruber crafted the 2020 Patient Protection and Affordable Care Act has little meaning, much like those who crafted the “crown jewel” of President Lyndon B. Johnson and his secretary of health Philip Lee, M.D., a health care system also known as Medicare. More profound is the state of health care’s “pit crew”, short in numbers while losing its collective metal following a three-year stint inside COVID-19’s epicenter.
No matter how pristine at inception, health care as it exists today in the United States is the product of partisan politics, seminal decisions by myriad federal justices, public interest groups championing select elements within the system, deficient and sometimes random fiscal allocations over the past fifty years, and fundamental disagreements over such things as when life actually begins or the propriety of when it should end. From this cacophony the United States forged a system more threatening than Edgar Allen Poe’s Raven and just as confusing as Lewis Carroll’s Jabberwocky. In response to the hypothetical “what could go wrong”, COVID-19 then wreaked financial havoc in biblical proportions on what remained.
This is U.S. health care, circa 2023, a place within which Lamborghinis, Porsches and Mercedes may still exist, but accessibility to most Americans comes as frequently as food and water did for the mythological Tantalus. Nevertheless, health spending in may reach as much as $4.8 trillion in 2023 and $6.2 trillion by 2028. As a result, health care must find a way to resolve an unforgiving list of challenges that most individuals simply do not understand, all of which exists in a system that rarely needs to be understood. For a modern-day society that effectively lives and breathes through a global system of interconnected computer networks that uses the internet protocol suite to communicate between networks and devices, challenges in understanding health care should not be surprising.
Axioms of Health Care
Health care does present certain assumptions upon which most people do rely without regard to the actual foundation upon which these assumptions exist. Some include:
These assumptions can provide much comfort in light of the health care system described above, and if true, the “how” and “why” are of no immediate concern. More important, these basic tenets fail to create a substantial drain from the nation’s multi-trillion dollar health care bank account. The real challenges, however come next.
Health Care’s Fatal Flaw(s)
At its core, health care combines patients, providers and payers within a system that often lacks preexisting agreements, which in turn leads to a multitude of directions by each part. Generally, patients aspire to pay little or nothing to the provider, who in turn expects all of its costs paid in full by the payer, or in the alternative, the patient. The larger infrastructure within which this dynamic exists has a multitude of federal and state rules that attempt to solve the issue only after an exhaustive inquiry into depths of regulatory oversight, which at times redefines health care through its complexity. The federal and state agencies responsible for creating, monitoring and enforcing this network of regulatory oversight well-known in health care expand the same with incomprehension and convolution while removing the subject of patient care far from the hospital bed. This in turn creates an enormous dearth of understanding that threatens to modify and even cease the treatment previously administered, which in turn can threaten once again the life of the patient. This is the point in time at which the patient, once comforted by the assumptions above, finally recognizes the treacherous path on which he or she now walks.
While not quite as bad as zugzwang in chess, any well-versed patient armed with the finest medical information the Internet has to offer should recognize disaster looms just around the corner. This in turn can lead to contagious decompensation and a series of forthcoming actions, forcing the provider to lose focus due to the threat of punitive measures, all of which create one of several more leaks in the aforementioned health care bank account. To make things worse, the patient can no longer dial 9-1-1, and there is not an ambulance in sight.
From here, providers must navigate the standard of care from high above the ground without a safety net below, and the only benefit such a vantage point provides is a clear view of a broken and overly expensive system. With familiarity long gone, the system engages a new layer of legal and clinical consultants who work tirelessly to recalibrate and identify their exact location. By now, with the primary focus away from the patient and provider relationship, the light that shines through the cracks in an already broken system can be blinding.
What Can Be Done
Once again, welcome to U.S. health care, circa 2023. This doomsday scenario is not prophetic but rather a harsh reality of the nation’s health care delivery system in Anytown, USA. It may take some time before health care in the United States can reverse decades of decay, but its fate depends in large part on patient inclusion in, and understanding of, the system upon which Americans depend to survive, or at least stay healthy. Because such a task is both monumental and generational, for now at least, it you happen to feel under the weather, perhaps it may be best to avoid the computer for your answers and see the doctor.
Craig Garner is the founder of Garner Health Law Corporation, as well as a healthcare consultant specializing in issues pertaining to modern American healthcare. Craig is also an adjunct professor of law at Pepperdine University School of Law. He can be reached at firstname.lastname@example.org.