Thursday, August 27, 2009

Synaptic Health Care and the Passing of Senator Kennedy and His Vision for Mainframe-Style Health Reform

The late Senator Kennedy will be laid to rest at Arlington VA on Saturday. His repose is a chance for all of us to reflect on his ceaseless advocacy for a just healthcare system, his appeals to all of us to help the least of us and his tireless efforts to achieve compromise over acrimony. Our nation owes him a great debt of gratitude.

The Disease Management Care Blog also wonders if his vision of government dominated health care will be laid to rest with him.

Mr. Kennedy belonged to a generation that believed in the greatness of government's role in modern society, and why not? Passage of Social Security Act of 1965 , the Civil Rights Act and other important social legislation demonstrated our collective ability to achieve new heights for modern America. Yet, something derailed Washington DC's momentum. What was started by the Great Society was slowed by the Reagan Revolution and reached its limits when Clinton's health reform failed. The DMCB believes Senator's Kennedy's passing may be marked as the beginning of the end.

An alternative world view is growing in our collective consciousness. It prefers networked over hardwired, parallel over serial, organic over static, tailored over pre-fab and synergy over reductionism. Its currency is communication, its actions are individually informed and the outcomes are fractal. It resists established business models and it certainly isn't taxable. It's face is YouTube, Blogging, Twittering, cloud computing and chaos theory while its symptoms are outsourcing, open sourcing, and multi-tasking. It can be easily mistaken for naivete, libertarianism, survivalism and conservatism. It's a wild card in our body politic; how else could Ron Paul become so..... cool? What else explains the misinterpretation of Federal payment for living wills as 'death panels?' It's not the 'web' and our 'Communication Age' only partially explains it. It's ....synaptic.

It is being underestimated by and hasn't helped those in favor of health reform. It has aided but hasn't been harnessed by reform opponents. Its cultural sexiness has greater appeal than the efficiencies from central command and control and its ascendancy is eclipsing classic liberal notions of social justice and progressivism. Government may be able to preside but it cannot own this. It is too complex, nimble and amorphous.

Which is why Senator's Kennedy's demise may be symbolic of the passing of an era. Whether it's big bang or incrementalism, and whatever its merits, the sun is setting on the likelihood of buy-in over the notion of a uniform benefit package being overseen by single authority. The DMCB doesn't think it's reached a majority yet, but the tipping point is fast approaching. When it arrives, the likelihood that Kennedy's vision will be fulfilled will be gone forever. This is another reason why supporters of health reform intuit that this last chance is not only hostage to the short term election cycle but to a profound long term trend. Taking Ver 1.0 reform's place is a Ver 2.0 vision of healthcare that is more local, responsive, personal, information-based, tailored, consumerist, rich and all those other terms that have been incorrectly dismissed as jargon. A telling example* can be found here.

That doesn't mean that experts won't continue to embrace a mainframe-style single payer, top down, highly proscribed system with regulated salaried physicians and policy being set by a Health Fed - for example, such as this article appearing in the New England Journal.

Waiting in the wings are folks like those who prefer a Guaranteed Healthcare Access Plan, consisting of vouchers that support a flexible minimum benefit. There are other approaches that meet the spirit of synaptic reform. Their proponents are waiting and watching to see what happens.

*Hat tip InsureBlog

1 comment:

Anonymous said...

Well said, Healthcare reform as currently viewed from the top is really healthoutcome reform ( in dollars or effectiveness depending on the viewer). What you are describing is more the rosy view from the bottom, which is more individualized and perceived as caring. Both can possibly coexist peacefully, but the conversation has not happened as of yet.