Ok maybe the title is just a hook. As far as “topics that come up often at Canadian dinner tables” this might be in the hall of fame. But it does fall victim to one of my favourite mental models pointed out by Shane Parrish of *Farnham Street Blog* called the illusion of explanatory depth. When you say that universal healthcare is “way better” are you thinking of situations where this isn’t the case? Are there drawbacks?
This column is going to look at how “Universal” and “non universal” healthcare systems work from four different perspectives.
Each perspective will start with a story of one major participant in the game we call the modern healthcare system. From that story, we will start with the incentive, also known as what is the #1 motivation for this player. Next, we’ll look at how the players are impacted on different levels and look at the biggest gaps or blind spots that could be addressed. The last part of the analysis will be the human factors that determine these shortcomings. Lastly, we’ll score each story using three pillars of value, namely clinical efficacy, economic utility and access/equity to care.
To say it gently, there is no way the system works as it should, but John Rawls’ Veil of ignorance thought experiment is one way of imagining how things ought to be. In short, if you were a fully conscious unborn baby floating in space (yes this is the real thing), would you be comfortable entering a lottery that determined the circumstances that you would be born into? A duplex in inner city Calgary? Or a temporary home in Poland as your parents flee the war in Ukraine. The obvious answer for me is no, I would not take that chance, but it’s that dichotomy, and my belief that healthcare provides the basis for a fair society that motivates me to do the work I do. So without further ado, let’s see if we can help out that space baby’s chances.
Patient
If we knew nothing about where we would end up, what sort of society would we feel safe to enter.
This one’s easy, it’s the person receiving care. Where this line blurs is when patients start paying for some or all of their care, in those cases, incentives and perspectives change.
Payor
Who foots the bill, its usually a mix, and always depends on the nature of the care, this can often be the hang-up and has consequences far beyond the bottom-line.
Provider
Who delivers the care. A nurse? Doctor, prosthetists, social worker? An AI? Lots of options here, all with there own motivations, both clear and clear as mud.
Innovator
Those whos job it is to improve and anlayze the beast that is healthcare, we are not perfect, but we like to say we are.
Clinical efficacy
Whether you are a beliver in Oolong or a clinical trials manager, clinical efficacy usually sits in the eye of the beholder, but for now, we will assume that you have some decent evidence to back up your claims.
Economic utility
Whether you like it or not, money matters. The more economically efficient a process can be, the more people benefit, and despite utopian yurning, the structure it provides is a necessary weavel.