Healthcare and Physics Are Not Simple

Make it simple. Make it short and simple. These are words of advice that I take to heart. A blog or for that matter almost any communication needs to have a purpose and be effective or it is not worth doing. When 

Betty says – Larry take out of the garbage – there is no mistaking what she means.

Those of you who read this blog know that I struggle with short and simple and I know I can improve. But this posting is all about why I sometimes rebel against such advice and think perhaps the extreme form of it illustrates why our country is in such a pickle. Some things aren’t simple and attempts to make them seem easy don’t help.

Let’s start by admitting that not everything is simple. No matter how many times you try, you cannot make physics easy. When I was an undergraduate at Georgia Tech majoring in Industrial Management in the 1960s, I was required to take one course in physics. To be honest, we IM majors were required to take “Cookbook Physics” from a professor who specialized in dumbing-down the real physics into something understandable by 18 year-old party boys.  But even Cookbook Physics was too hard for most of us and we were lucky to have a tutor named EE Bortell. I owe Prof. Bortell much.

It is true that most of us generally understand the meaning of “what goes up must come down” but it is also true that we really do not fully understand the law of gravity. Apparently there is a giant sucking machine somewhere in the center of the earth that helps keep our feet on the ground at least until we drink that last JD of the evening and try to moon walk across a floor with a six inch orange shag carpet. When it comes to designing and building airplanes, my hope is that the engineers at Boeing know a little more than “What goes up must come down.” That is, I hope they studied aeronautics, mechanical engineering, and whatever else it takes to really understand how to get us safely from point A to point B.

These studies take time and involve mastering many concepts, theories, history, Michelangelo’s David, and other considerations. If two Boeing engineers want to argue about the best way to design the newest aircraft, I doubt that most of us who have not studied these subjects for thousands of hours would really understand the arguments. We might listen attentively for words like crash or extra rare steak – but we really don’t have the background to effectively decide which engineer is right and which one is wrong. We would hope that experts would make the decisions and our role would be to buy tickets, fly business class, have our luggage lost, and go to someplace really nice in Italy.

Imagine how the tone of all this might change if we normal human beings were asked to adjudicate or vote on all Boeing technical decisions! Imagine that Boeing didn’t really care about having the best airplanes in the world – they just wanted to get public acceptance or love and approval. To get your vote, Boeing Engineer 1 shows you vivid detailed color pictures of crash victims and explains that his opponent’s system might lead to faster aircraft but with a much higher risk of system failure. Engineer 2 shows you getting off the plane in Italy (did I mention our vacation in Italy?) two hours after leaving New York and shows you eating pasta, making business deals with gondola drivers, and otherwise saying things like guten journo and merciprego.

You laugh but whether it is a debate about Medicare or government budgeting issues, most of us don’t know squat about these things and our elected representatives and friends in the press treat us like idiots. Perhaps they are the idiots but for the sake of this argument it doesn’t really matter.  Medicare or healthcare policy in general offers great examples. To REALLY understand the issues in healthcare you ought to at least understand the roles played by everyone in the value chain – nurses, doctors, hospital administrators, medical device and pharmaceutical companies, insurance companies, and Dr. House. You also need to have some understanding of how technological, legal, economic, and other trends and changes are impacting decisions of these entities. Of course, you also need to understand the motivations and actions of people who demand healthcare and the role government plays in impacting their decisions. That’s a lot to master for the average person who thinks that Australia is a US state and who can barely turn on his TV without the help of a 14 year old grandchild.

Like decisions at Boeing these decisions about healthcare are not simple and are not easy to explain as we normals debate the best systems. So what we get are watered down and dramatic oversimplifications which have very little to do with the real issues and everything to do with scoring votes –

o   Death squads will murder your Uncle Bob

o   Republicans will push Grandma Betty over the cliff

o   Pharmaceutical companies only care about making money and make huge, obscene profits

o   Government is needed to protect people from companies

o   Companies are needed to protect people from government

It really isn’t about any of those points. There is a belief that the US should have a healthcare system that includes everyone. So benefits have been extended to nearly the whole population. Before this legislation was passed, costs were rising at unsustainable rates and creating challenges for the system’s viability. Adding millions more people has the potential to constrain these cost increases but much of the new healthcare program does not seriously and convincingly get the job done. Thus we are left with a plan that could add to the bankruptcy of a nation already on the verge of financial breakdown! No plan that includes both widespread inclusion and cost control is going to make everyone happy. Someone is going to have to lose something. This is not easy stuff. Where is EE Bortell when you need him?

I think you get my drift. Most of us don’t really know anything about designing a healthcare system for 300+ million people but when some of the “experts” tell us colorful and outrageous things we either (1) nod and acknowledge the opinions of the experts we like (from our political party) or (2) we hoot, holler, and ridicule those we don’t like (in the other party).

This is no way to get to the moon and it clearly is no way to design a decent healthcare system or balance our ballooning national budget.

Isn’t it weird how we let politics determine so much of what impacts us? Imagine if we had to get a majority of politicians to help us decide things like: the best way to drive from our house to our favorite restaurant; whether to select Android over Apple; if our children will play soccer or piano; and so on. The point is that many decisions SHOULD NOT be determined by the political implications – they SHOULD BE determined by the specific merits of the arguments.

So if this makes sense for most of the things we do every day – why does it not make sense for other important things like healthcare and budget balancing? Why don’t we just say – Harry, lighten up and do what is best for the country.  Duke it out all you want but eventually get Jim and some real experts into a room and don’t come out until you have compromised on a decent solution. Tell all those fringe folks to take a hike.  I know it takes some real cajunas to stand up to those squeaky wheels but in the end you probably don’t need them anyway.  In our jobs and families most of us have to use logic over passion when making decisions. Why are we so docile about requiring the same of our politicians?