| This is a systems interface essay. The lede is buried very deeply: It’s like one those post-apocalyptic science fiction novels whose characters hunt wild boars with spears in the ruins of a modern city. Surrounded by machines no one understands any longer, they have reverted to primitive technology. Except it’s in reverse. Hospitals can still operate modern material technologies (like an MRI) just fine. It’s social technologies that have broken down and reverted to a medieval level. Systematic social relationships involve formally-defined roles and responsibilities. That is, “professionalism.” But across medical organizations, there are none. Who do you call at Anthem to find out if they’ll cover an out-of-state SNF stay? No one knows. The author recommends hiring a consultant. I'd like to suggest an alternate approach. In complex disputes between parties, we have several systems or dispute resolution. One is to engage the services of an alternative administrative system: the courts. While Anthem may be governed by 1,600-page rule-books, a judge is not. Or rather, a judge has a different set of rule books and considerable autonomy to make decisions independently. (With provisions for review.) One way of considering this is as a collapsing of complexity: where a system becomes too complex to function reasonably, a third party is called in. The U.S. healthcare "system" has become vastly too complex to function with any semblance of sanity. It is in desperate need of a complexity constraint being applied to it. What we might in other political contexts call a revolution. Perhaps a reform. But it seems vastly beyond the realm of incremental change. |