What’s Next?
For many years, the driving force to my work was stimulating fundamental change in America’s health care system.While doing so, I recognized the miracles of modern science and the overwhelming predominance of good intentions on the part of those engaged in health care delivery.But the defects of our system were evident- high cost, mediocre outcomes for the massive investment, and inequities galore- and crying out for big solutions.
Then, as now, my view was that the core defect was the excessive fragmentation of health care service and financing, and its inability to function like anything resembling an effective system.
Recent events reinforce this diagnosis.It came as no surprise that an initial vaccine distribution premise of providing doses to the nodes of the health care system with a hope that these nodes would expeditiously and fairly provide it to the public was fraught with danger.Thankfully, we have turned the corner and replaced this premise with tactical distribution through a myriad of health care, public health and social methods. Bewildering yes, but far more effective than before.
The vaccine experience is but another example of the true cost of our disorganized and at times grossly ineffective health care system. The stakes were already high in needing a solution and have escalated further.Unfortunately, the past year has also left me questioning like never before our capacity to engage in the honest and hard work to achieve a fundamental change of our health care system.
There was some personal good news on this front- the lockdowns gave me the time to contemplate my own thoughts on fundamental change substance and process. This largely translated to my completing a health policy novel called “The Theory of IRV”. I wrote most of it during the March to May lock down and finalized a prepublication version in the Fall.
It is a public health detective story, wrapped around a telling of the history of our health care system and potential solutions to its ills.My novel is available at no cost to those wanting to review and comment. Let me know if you are interested in receiving an electronic copy by emailing me at gregvigdor@cox.net.
I stand by my prescriptions for change contained within The Theory of IRV.But must consider anew how we can get to these or other solutions given where we find ourselves as a nation. The policy changes we need are hard enough, and now made practically distant by the question of whether we can agree on any solutions in our most divided society.
Much of the Washington Health Foundation’s (washhealthfoundation.org) work over twenty years was to find agreement on practical and meaningful solutions to health care problems so that we could make progress, including on major health reform.Our belief was that there were consensus values and beliefs that transcended classic political divides and that we could find agreement that was actionable.Generally, we found it- and were able to activate ways to make things better without getting dragged into the conflicts of the two political parties and their rhetoric.
Now, it is hard to imagine how we can do that.Even civil discussion about these matters is unlikely.We tend to live within our own bubbles, and the “news and facts” inputs into these are decidedly limited.Many, maybe even most of these, are designed by their authors to reinforce the division, whether for their own ideologic, power or financial gain.
How can we move ahead on consensus solutions when there is so much that seems to divide us?It has gotten so poisoned in public discourse that many even question if we really do share common values about what it means to be an American in the 2020s.
Back in 2003, our Foundation explored whether there were common values about our health care system in Washington state. Even then, there were those who told us that no agreement would be found.But, we forged ahead anyways, by listening to people and communities across the entire state, in a structured process over many months.
We were able to identify 10 consensus values that had great resonance for a wide swath of the people of the state, far more than majority or even supermajority political percentages.The top three were belief in the need to assure fairness and redesign the health system by re-allocating existing health resources.This became our platform for the successful Healthiest State in the Nation Campaign.
If we undertook that values discernment process again today, would we find such strong agreement for these basic tenets?I think so, but am not sure.I wish we had the resources to make another run at discovering the answer to this question now.
Somehow, we need to find a new agreement among most of us as to what our reality is and how we might work on it more together than apart.Including around how to fix our broken health care system.The current divisions are tearing us apart- in our response to the pandemic and and other issues regarding whether people live or die.
Maybe there is a vaccine for that too.