The Health Care Paradigm


The Middle East has been in the news a lot; the Middle East is the news, with its tentacular failures reaching out to all and sundry, near and far, friend and foe. It sticks like Velcro to anything that has ever passed; it is the spider at the center of a web whose boundaries are still enlarging, still entangling.

At times I am reminded of Health Care -that primitive god appeasable only with sacrifice, but beset with failed diplomacy and feints and posturing. The intentions are laudable but the reality -or the contingencies surrounding that reality- too complex to allow much change. It’s almost as if the assessment were so constrained by circumstance, by need, by good intentions, so shrouded in expectation that no one could see that it was naïve. Unworkable. Even the most optimistic approach is unpalatable to many and dangerous to a few. And in the end, no one, let alone the participants -the victims- are satisfied.

Both situations are subject to similar biases: the ultimate goals are probably unachievable without radical changes –paradigm shifts. Thomas Kuhn in his book The Structure of Scientific Revolutions (where the concept of paradigm shifts -world-view changes- was most forcibly presented) suggested that system changes occur more readily when so many anomalies accumulate in the usual approach it has to be abandoned. Unfortunately, unless another more appropriate theory is ready to jump in and replace the old one, things can drag on inefficiently, often with disastrous results. Be careful what you wish for.

Health Care, like politics in the Middle East, requires a new approach, a new paradigm. When we come home from a long and vexing day, wearing all the unresolved issues it wove, we are comforted by the predictability of our house -the orderliness of a room, say: the vase on the table, the juice in the fridge, the magazine where we left it on the shelf by the couch. It is an oasis tucked away from the world, safe and unchanged. Most of us desperately want -need- the world to be like this: predictable, reassuring, changing little and only within our comfort zones. All therapeutic perhaps, but nonetheless beside the point. Irrelevant. It’s just not how things develop; there is an evolution inherent in issues that is beyond our ken. Our desire for refuge solves little. And yet…  By taking us out of the fray, it may allow us a more dispassionate view of what we left behind. Contrast is sometimes the way out of a paradigm: a sudden light flashing in the dark.

The old way of looking at it has not worked. Our objectives may be noble; our solutions, however, are necessarily coloured by reality. Economics. Politics. For example, in Canada at least, our Health Care motives seem to be laudable: let no one go untreated, unnoticed, uncared for. And yet we know many are. Politicians insist they are pouring more money each year into the system -and no doubt that is the case. But it seems to me that it is akin to bailing a boat with a hole in the bottom; it is doomed to sink. What is needed is a new boat, not a new patch… A new design. A new fabric to make the boat.

And yet, rapid change often begets rapid and usually unanticipated problems. Even new paradigms do not come with guarantees; new clothes -beautiful and desirable ones included- do not always fit. Sometimes one has to measure for need as well as appearance. And measurement is an interesting concept; it entails viewing something in a new way: not how it appears superficially, but rather assessing its components and calibrating them in some consistent and verifiable manner. Not so much the size of the problem -that can be dealt with separately- but the components of the thing measured and the way they aggregate. The way they work. The size of a molecule is one thing, but the way it is put together may more successfully determine the way it interacts with the things with which it is mixed. That may be a better thing to measure… Reality rarely comes uncombined, unmixed, unassembled.

So in the case of Health Care, the situation is often reduced to its ever-increasing expense, its insoluble complexities; or it becomes mired in the mud of one problem or another adding yet another passage to the labyrinth… All, it seems to me, measuring the wrong things: the appearance, the effects, not the way it is put together. We know what we want it to do, not how to make it perform. So in geopolitics as well as in Health Care, maybe we have not yet talked enough to the other side -listened to its opinion, modified the equation. Maybe we’re so intent on what we want to be the answer, we miss the fact that it isn’t. For an equation to work, what appears on one side of the equal sign has to be in balance, in harmony, with what is on the other.

And what, after all this, is my response? Perhaps only the observation that, despite the desperate need, the paradigm has not yet shifted -it is still the same old worn out animal dutifully charged with clearing the pasture. But, more alarmingly, that perhaps we don’t even realize it is just a paradigm… and not the only one.

 

 

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