Lessons From A Health Care Christmas Carol: The Haunting Of Three Spirits

No wonder Jacob Marley is grumpy.  He's not only dead thanks to complications following a minor surgical procedure, the links of his ephemeral chains binding his wandering soul were individually forged with every uptick in health care cost inflation. His ledger was without outcomes and his surplus without savings.  His business should have been health and his profit prevention. 

For the Disease Management Care Blog, this doomsayer is more than a blot of undigested mustard or a missed dose of an anti-psychotic.  He brings a remorseful message about weak research, academic consultants and government meddling.  We ignore this spectre at our peril.

Jacob tells the DMCB readers to take heed, for they will be visited by three ghosts!

First will be the evanescent Ghost of Healthcare Past.  He flits in and out of sight in the policy salons with inferential, observational and conditional estimates of the past impact of unseen spirits like "PCMH," "ACO," "VBP" and "bundling."  If these sips of spiked holiday punch fail to convince a coldly skeptical world, this spirit can always point to the anecdote of the Tiny Tim who, but for access to patient centeredness, wouldn’t have become such a naïve, dimwitted and crippled believer in government-run healthcare. 

Then the academic and corpulent Ghost of Healthcare Present will appear. He has been feasting off the largess of a system that rewards the confidence that comes from fashioning economic cause and effect relationships out of hope, holly and mistletoe.  Festooned with a crown of academic credentials and a velvet robe of plausibility, this pleasant apparition loves nothing more than to feast with spectral policymakers in the warm glow of mutual admiration, obscure modeling and publications that go unread by the living.  Best of all, by being a Ghost of the Present, he can ignore the past and will never have to take responsibility for the future.

Then the fearsome and faceless Ghost of Healthcare Future will intrude.  He cruelly points a crooked bony finger at an unkempt and forgotten tombstone in the cemetery of long dead medical practices, like cupping, paper charts and physicians who actually talk to patients.  In the dim moonlight of fixed budgets and the bitter cold of Big Box Store health care, the inscription names “commercial private insurance” as the interred.  Is this what could be, what will be or what should be?