Reforming healthcare

Reforming the healthcare system is a Herculean task. One reason for this is the current fashion of effecting change via the input of stakeholders. This is a common-sense premise in theory, but in practice eventually becomes "which hogs will have their snouts in the trough?" One basic premise of healthcare reform is that it is impossible to accommodate everyone's pet interests without ruinous cost. As a result, practical healthcare reform must begin with considerations of cost management, and consequently, what is it that makes healthcare so expensive. This question may be divided into two parts: what practical considerations make healthcare expensive, and what policy considerations make healthcare expensive. The former question was addressed here previously. To begin investigation of the latter, we may begin with some empirical observations. To the question "what policy considerations make healthcare expensive?" we can start with:

1. Ideology is expensive. To the extent that healthcare policies are meant to reflect cultural or political interests, they will create inefficiencies and be accompanied by otherwise avoidable costs;

2. Unrealistic expectations are expensive. Pretending that terminal patients are not terminal, or that everyone can receive the same quality of care, or exactly the same level of care creates a financial drain that increases the costs of healthcare with no benefit other than transient pretense;

3. Emotional indulgence is expensive. emotionally satisfying outcomes are often opposed by hard realities. Creating policy prescriptions that assume otherwise is quite costly;

4. Impatience is expensive. Haste does quite literally make waste. Doing the right thing tomorrow is much more cost effective than doing the wrong thing today. waiting for systems and technology to mature and be refined takes time and discipline; profligacy does not;

5. Confusing desires with possibilities is expensive. A great deal of resources may be wasted trying to bring into existence what we think we want rather than what we can actually attain.