Fixing American Healthcare: Bringing covert rationing to the light of day to encourage real change in our health system
Dr. Rich Fogoros sent me a copy of his latest work,
Fixing American Healthcare: Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare
Its a book I highly recommend anyone interested in the system to read–and it takes more of a sociological/ historical approach reminiscent of the best parts of Demanding Medical Excellence and The Social Transformation of American Medicine. Where Porter’s Redefining Health Care and Herzlinger’s Who Killed HealthCare? highlight what a more consumer-focused system might look like and why the current system is a mess, Dr. Rich gives us a very clear understanding of why the current players have very little incentive to make that consumer-centered dream a reality.
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highlight what a more consumer-focused system might look like and why the current system is a mess, Dr. Rich gives us a very clear understanding of why the current players have very little incentive to make that consumer-centered dream a reality.
At the heart of his argument is the Grand Unification theory of Healthcare. It is represented by a deceptively simple 2×2 matrix (seen to left) presenting decision-maker against decision quality. Dr. Rich’s assertion is that we are currently in the realm of Low quality, individually-driven decisions (Quadrant IV). Making decisions more standardized by creating better efficiency through centralized decision-making would bring us to Quadrant III– which still doesn’t take us very far, as the decisions made by the centralized power would be of extremely low quality and limited by a centralized budget– creating a situation where covert rationing is the only way to keep the budgets in check.
