Winning the Healthcare Revolution

The sick-care revolution has started. Battle lines are drawn. Forces are gathering. Militias are recruiting foot soldiers. But, like all revolutions, the attack on the perceived injustices of US Sickcare, Inc., could fade with a whimper or create real change for the better. According to one author, the result will depend on four things.

Successful movements do things that failed ones don’t. Namely, they create clarity of purpose, forge shared values, plan effectively, and connect to the mainstream.

Clarity of purpose. One such outcome is the Triple Aim of improved outcomes, reduced per capita costs, and a better user experience. The purpose of healthcare reform is to optimize scarce resources while solving the Rubik's Cube of quality, cost, and access. Some feel that the goal is not achievable, and that you only get, at best, two-thirds. Others claim that the purpose of reform is to make care more affordable, patient driven, and transparent and that will improve access and quality. Simply shifting the costs to patients with high-deductible plans is not successful.

Forge shared values. The multiple healthcare systems around the world are, in large part, a reflection of the values of the society. American values include personal freedom, independence, equity, fairness, a suspicion of centralized government, personal responsibility, and a meritocracy that rewards individual initiative. Of course, there are many examples of trends and actions that don't reflect those values. Fundamentally, however, the basic ethical precepts of medicine have not changed over many centuries and include :

• Autonomy: People have the right to control what happens to their bodies. This principle simply means that an informed, competent adult patient can refuse or accept treatments, drugs, and surgeries according to their wishes. People have the right to control what happens to their bodies because they are free and rational. And these decisions must be respected by everyone, even if those decisions aren’t in the best interest of the patient.
• Beneficence: All healthcare providers must strive to improve their patient’s health, to do the most good for the patient in every situation. But what is good for one patient may not be good for another, so each situation should be considered individually. And other values that might conflict with beneficence may need to be considered.
• Nonmaleficence: “First, do no harm” is the bedrock of medical ethics. In every situation, healthcare providers should avoid causing harm to their patients. You should also be aware of the doctrine of double effect, where a treatment intended for good unintentionally causes harm. This doctrine helps you make difficult decisions about whether actions with double effects can be undertaken.
• Justice: The fourth principle demands that you should try to be as fair as possible when offering treatments to patients and allocating scarce medical resources. You should be able to justify your actions in every situation.

Plan effectively. Each special interest has a plan. Some have more money, power and influence, but, as history has shown many times, that is not the deciding factor. While, as we all know, no battle plan survives the first shot, successful revolutionaries have well thought out strategies and tactics to achieve their objectives. They use information, logistics, media, recruitment tools and the charisma of their leaders to achieve success.

Connect to the mainstream. No revolution lasts without winning the hearts and minds of the mainstream. Fringes don't last and often create counter-revolutions. Most importantly, change does not happen from inside. It must come from and be sustained from outside and be engrafted into the new culture to prevent relapses.

US sick-care is a system of systems. In addition, each system is composed of various subgroups vying for influence. They include doctors, non-doctors, payers, health service organizations, patients, policy makers, and regulators to name a few.

It seems we have some work to do as revolutionaries. Our purpose is not clear and convincing. Our actions are not reflective of our core values. Plans are at cross purposes. The 99% feel disenfranchised.

Winning the revolution will take extraordinary leadership and organizational skills. Perhaps combat fatigues are more appropriate than white coats and scrub suits. They might even spread less infections.