It doesn’t compute
Complex, entrenched problems in healthcare continue to defy solutions
As of last week, the U.S. could once again claim some long-lost bragging rights in the science and technology arena. For the first time since late 2009, our country is now home to the fastest “supercomputer” on the planet. The new data-crunching champion, dubbed Sequoia, was built by IBM Corp. for the Lawrence Livermore National Laboratory in California. It performs 16.32 quadrillion calculations a second (a quadrillion is a 1 followed by 15 zeroes).
Sequoia’s primary job will be to run sophisticated models that allow scientists to assess the capabilities of nuclear weapons without the need for real-world underground testing. Sounds like a sensible option. But supercomputers also are being employed to advance more down-to-earth pursuits such as ever-longer-range weather forecasting, and in healthcare, improving the scope and accuracy of evidence-based medicine, among other research.
One task that still might be too much of a brain twister even for Sequoia is solving the problems that continue to plague our nation’s healthcare system.
U.S. healthcare lost its bragging rights a long time ago on too many fronts. While the industry continues to attract some of the best and the brightest from around the world, everyone knows the big picture isn’t pretty. The issues are familiar: Too many Americans lack access to care. We spend far more than any other nation per capita yet get subpar results on quality. For those with health insurance, they might still be one chronic illness away from financial catastrophe.
The Patient Protection and Affordable Care Act alone can’t fix all those ailments, but it’s made a start. This week, after the U.S. Supreme Court finally rules on multiple legal challenges to the ACA, the debate will need to start anew, no matter what the justices decide. Do we have a set of national priorities? And how will we get there?
For decades, American presidents and members of Congress have been asking similar questions. The core problems in healthcare really haven’t changed much since the Great Depression: cost, quality of care and fairness in access. Progress has been made over the years, including enactment of Medicare, Medicaid and the Emergency Medical Treatment and Labor Act, to name a few legislative accomplishments. But shortcomings persist.
Invariably, whenever proposals challenge the current system, it doesn’t take long for warnings to be sounded: Governmental meddling equals socialized medicine. And any new regulation will surely necessitate “rationing” of care, we’re told.
But rationing is deeply rooted in our healthcare history, often the result of unintended consequences. How that has played out is chronicled in a new book, to be published this fall, titled Health Care for Some: Rights and Rationing in the United States Since 1930, by Beatrix Hoffman, department chair and an associate professor in the History Department at Northern Illinois University.
Rationing was certainly part of the discussion in the runup to passage of the Affordable Care Act, especially with infamous comments about the specter of “death panels.” But such hyperbole only masked the fact that various forms of rationing were really the status quo.
How do we ration? Hoffman helps count the ways, including by cost, income, health status (those pesky pre-existing health conditions), job status, type of health plan, coinsurance, deductibles and tiered pricing.
“The idea that we ration is still not widely accepted today,” Hoffman says in an interview. “It’s absolutely essential that we talk about the kinds of rationing we are doing and have a discussion about whether that’s what we want.”
Let that discussion begin.