I’m not ignoring reality. I know that if millions of people get thrown off the cliff and into the pit of healthcare hell, people are going to die. As a former national clinical systems healthcare liaison, project manager, industry analyst and change management consultant, no one knows that better than me. Considering, however, the likelihood that people have already died over lack of access to care or the ability to pay for it, and that actors from both political parties have perpetrated those deaths and their causes, I can’t resist a deep dark part of me that thinks throwing everyone over the insurance and healthcare industry handlebars may be just the stick in the spokes we need. The healthcare discussion has hardly moved since the early ’90’s. I know, because I was in that discussion.
And what discussion is that? Real reforms should have taken place in the early 2000’s, but the GOP BS coupled with the Dems/Clinton legacy of their preferred contractors piling in on initiatives as highly paid consultants whose main goal and actual stated job description is to find and land the next follow on gig… well, they milked any progress out of actual progressive or helpful change. Instead of working on making sure Americans can stay healthy, a proven element on every single available measure as necessary to any other activities in America, our legislators have perpetuated rising and falling tides of profits to benefit the insurance companies, and disguised the disastrous healthcare results with carrots called profit and jobs. It’s an illusion.
In another project I worked on, legislative efficiencies and advantages that should have been architected and derived long ago, were completely sabotaged to keep the public from having access to their “un-narrated self-guided tours” of the law-maker’s sausage factory. Or, as Hillary Clinton put it in her infamous speech to Goldman Sachs, you have to have a public and private narrative because people tend to get nervous when they see how things are getting done. The walls were kept in place and the networking delayed to satisfy secrecy and territorial kingdom building both in our bureaucracy and in our industrial giants. There’s nothing like having spent half your professional life negotiating data exchange and service level agreements and arguing data category access with the feds to give you a little “inside” as to “how it’s done.”
Would you believe me if I told you that the biggest reason we don’t have single payer insurance today is because doctors refused to allow a single unifying identifier assigned to each physician to track efficacy of treatments and billing practices? Do you know why – why that one single HIPAA data element screwed healthcare for the next 25 years? Because the only record that tied such needed data together was their license number, which is tied data-wise to their income and taxes, which shows their ties to the big pharma and incomes they receive from “moonlighting” sources… and MDs didn’t want people being able to know, nor did they want the IRS and the government to find it all out. The industry spent the next 10 years trying to find a way to do that around their steadfast and power fueled refusals. What no one seems to notice or comment on is how the problem was solved through Obamacare and through building of the IRS-linked health networks that did it in reverse. Instead of tracking physician incomes, that little hidden data twist effectively saddled the TAXPAYER with the problem, changing the data from income to data about the consumer’s money and their ability to pay. So we have an accounting system in healthcare based not on the industry’s practices, but on the practices and traceable data mining from the consumer. It’s why our numbers are so off and the system isn’t fixable as it is. It’s based on your ability to pay.
We have to be careful with single-payer too. The obvious difficulty here is another reality tidbit that no one discusses. There’s a real and serious doctor shortage. If we opened healthcare to every one of our 300 million Americans, each and every one of the currently 208,000 general practitioners in this country would be responsible for more than 1500 patients’ basic medical needs. OBGYN needs would make each doctor responsible for a 5,500 patient load. How may OBGYN doctors do you know willing to handle the care of 15 + women per day? How many women do you know who would be satisfied or well taken care of receiving that kind of time commitment to care? Even more hidden surprises await when the topic of information technology and data arise.
Unless we get the security issues in hand, your healthcare record and all the data tied to it now, are soon and about to be used as the single-most powerful “big brother” tool imaginable. Stay alert. It’s coming. In fact, it’s already here, just waiting to grow. Obamacare and the electronic healthcare exchange financial applications alone made immigration tracking completely doable at the throw of a couple of data stream switches. No one is going to be rounded up and tested for their religion. You gave them that information so they’d know what to do with you if you needed any religious rites or clergy. You’ve already given them the biological testing materials necessary to identify you down to the last time you travelled when you showed up for blood tests at the lab. Not coincidentally, the “Medicare for all” thing is a disaster waiting for a place to happen – it’s turning over this info TO the government. That government, in Obama’s exiting hours, is setting up the final networking mechanisms to turn everything – like your student loans and subsequent taxes linked to your ability to pay for your education – into regulatory and policy decisions that are going to affect everyone in monetary and not a very humanitarian results-driven ways. And stay away from those Ancestry DNA tests. You and your children will know your ancestry intimately better when that unregulated market gets your consent to use and share your predispositions with the insurance and banking industries and your bills are adjusted accordingly with lasting “memories” for you and your family evermore. Conscience is something they left behind long ago.
In a recent article, one of the main news stories finally and correctly linked the data situation to the pioneering work we did in the defining days of HIPAA and healthcare. Like the discussion, the recommendations both I and others made were the same. WE need an independent data owner and controls on access – YESTERDAY. We need to establish a library – yes, the internet makes this entirely possible, YESTERDAY – that houses all data, and which can only be accessed with recognized, authorized digital and physical requests. The entire world of Information Technology is set up this way. Where it went wrong was when data started being diverted and manipulated to accommodate marketing edge, advertising goals, and Madison Avenue approaches to both security and privacy, all in the capitalist name of profit and market control gains.
Healthcare, then and now, is always a unique testing ground for whether or not the human factors of a decision have been considered and weighed. We knew then, in the meeting and Board rooms that I was in, that what we did would ultimate and literally impact whether people died. A 7 second “real time” response standard for banking wasn’t good enough in healthcare where the Emergency Room ceiling for receiving information was 3 seconds. The difference then, and now, was in how many ACKs and tags and switches and routers and data splits were involved between request and delivery. Today, it affects your delivery times every time the program or service you want from your cell phone or electronic device and even your television, is slowed down by loading up all the metadata and accoutrements for ads. What happens before, during and after your computer is showing you your data access request is first (order of service), accommodating, accessing and proliferating “service agreements” also known lovingly as ads. I remember the battles and the arguments and the disappointments as the Clinton contractors arbitrated for “sensible” standards that we could improve on over time. Again, not coincidentally, this was the same time when consulting IT specialists’ 2nd job performance requirement was to identify and push for follow on “opportunities” and extensions on contracts. And yet again – what happened before and next is important. Most of those contractors came from government contracting agencies and most of their interest was in owning data. You see, in IT, typically, if you own the data, you get to charge for the use of it. The other cost centers are in storage and access and transmission times, so the folks who control those things are the folks really running the show. Today, direct from consumer to the big guys, your data goes on a circle tour of abusers, and the personnel migrate from government to industry and back again. All they have to do is continue to manage and consolidate the network, control the assets, and deliver on the SLAs.
How was this perpetuated? How can something clearly so worrying have come so far and gone so wrong? Again, healthcare provides the groundbreaking example for what could have happened, but what didn’t get done. But it could. Between 1999 and 2009, some $6-7 trillion were wasted on perpetuating busy work and useless jobs. The brunt of the money was spent being shuffled between contractors and awarding agencies managing contracts driven by pay-to-play agreements while ignoring easily measured actual results. The pattern then and now – short schedule and short fund any planning. Instead, let the “experts” supply that during the Initiation phase, and then just build the requirements to version one deliverables and scale. Bring in temporary contractors who are trained by the experts to work the new technology in favor of the more expensive option of transitioning legacy employees and providing training and learning curve provisions into your implementation costs. Foreign, cheap, skilled labor is the first choice option. Need I say more?