Health Policy

Healthcare Should Get Into Some #GoodTrouble


As hopefully most of you know, Rep. John Lewis, civil right icon and longtime member of Congress, died this past Friday.  Rep. Lewis was often described the “conscience of Congress”  – perhaps a low bar in today’s Congress but important nonetheless — for his unwavering commitment to social justice.  I have always been struck in particular by one of his quotes:

Rep. Lewis must have been heartened by the fact that, in 2020, plenty of people are, indeed, making noise and getting into good trouble, necessary trouble over issues that he cared deeply about, like Black Lives Matter and voting rights.  There are others who are better able to write about those people and that trouble.  So I’d like to talk about his call to action with respect to healthcare.

If you are working today in healthcare — especially in the United States — or, for that matter, someone getting healthcare or having a loved one get it, then you should be making some noise and getting into good trouble, because our healthcare system most definitely makes it necessary. 

It should come as no surprise that we’re not very happy with our healthcare system, rating it lower than do citizens in most other developed countries.  And for good reason: it’s the world’s most expensive while delivering sub-par health results and leaving tens of millions without financial protection.  Even our physicians don’t like it.  Even our latest, best effort for improving the sorry state of our healthcare system — the Affordable Care Act  – is under risk of repeal due to a lawsuit brought by 18 states and backed by the Trump Administration.  

Every day, too many of us suffer in the healthcare system, ranging from waits to indignities to critical mistakes, and some face financial ruin due to the care — whether good or bad.  Most of us suffer in silence, or only complain to our friends and family.  We don’t see a lot of mass protests about the pitiful state of our healthcare system, and I have to wonder why.  

We have to stop being so passive.

For those of you working in healthcare, here are the first two things I’d urge you to get into good trouble about:

The first admonition comes from a movement developed by Melinda Ashton, MD at Hawaii Pacific Health.  She started asking front-line workers to identify things that were “poorly designed, unnecessary, or just plain stupid,” and — not surprisingly — there turned out to be a lot.  Someone just needed to ask and to promise some action.

Why every healthcare system/organization does not have such a program is beyond me, because those front-line workers see those kinds of things every day.  They probably do make some noise about them, but many may not be willing to get into good trouble over them, nor are they usually supported by their leaders to do so.  

But, still, they should be trying.

The second comes from advice that Dan Gingiss gives about improving customer experience.  Our healthcare system is the world’s largest Rube Goldberg machine, complicated beyond understanding and with much of that complexity not achieving intended goals.  “Complicated” isn’t the same as “sophisticated,” much less “better.”

Yet we continue to add complexity, layering new technologies onto old, inserting new layers and new types of intermediaries, all of which adds costs.  Even things that aren’t inherently stupid are usually more complicated than is absolutely essential.  

Before we make things even more complicated, we should focusing on making the simple things better.  Who is getting into good trouble about that?    

I’ll give some other examples.  The Commonwealth Fund and Manett just put out a report about transforming primary care for women, and one of the recommendations was the recommendation to expand women’s leadership in healthcare.  As one of the authors, Lisa Suennen, wrote in her blog:

In a field where only 4% of all healthcare company CEOs are women and only 19% of hospital CEOs are women (a subset of the other number), policy is made by men. Physician education is also designed by men, who make up 2/3 of active physicians and 84% of the deans and department chairs at the 154 member medical schools in the United States. 

It shouldn’t just be about primary care, nor even just about women.  If the leadership at your healthcare organization doesn’t resemble the workers in it, or, equally important, the people receiving care from it, then you should be making noise.  That’s worth getting into good trouble about.  That’s necessary trouble.  

Or take prices.  As expensive as our healthcare system is, we’ve known for a long time that our problem isn’t getting too many healthcare service as it is the prices we pay for them.  If you’re working in a healthcare organization that charges the people without health insurance much more, you should be making noise.  If your organization is also suing those patients to collect the resulting debts, you should be getting into good trouble to try to stop it.  

And, of course, if you are working in a healthcare organization where you see patients getting services they don’t actually need, or, worse yet, delivering substandard care, then you really should be making noise and getting into good trouble.  That is definitely necessary trouble.

But it’s not only those working in healthcare.  If you or your loved one is receiving care, you should be making noise when you aren’t treated with respect, or when you don’t get the information you need.  Standing up for your rights, especially the right to make informed decisions about your care and your health, is worth making good trouble about.  It is necessary.  

All of us should be getting into good trouble about the shameful health disparities in our nation, which reflect the equally shameful socio-economic disparities we have allowed to persist.  All of us should be getting into good trouble about the fact that a healthcare episode can wipe out a families’ savings, even if they have health insurance.  All of us should be making good trouble about how much our nation spends on healthcare for such a poor health return.  

We can’t be afraid to make some noise about healthcare.  We must be willing to make good trouble about the many, deep, and pervasive problems in our healthcare system.  If that isn’t necessary trouble, I don’t know what is.  

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented, and now regular THCB contributor.

Categories: Health Policy

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  1. “Kim is a former emarketing exec at a major Blues plan”

    My experience with BCBS here in North Carolina is it’s in the thick of the cause of the problem. Ever increasing rates while the “non-profit” status allows millions to be siphoned off in executive bonuses.

    There was also a pattern of multiple lost paperwork and delays to frustrate premium payers on getting what is owed to them in claims. In fact I know a fellow who business is getting BCBS to pay legitimate claims.

    So what has caused your sudden epiphany?