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Rudderless Roulette

My father-in-law celebrated New Years Day by breaking his hip.  He had been sleeping in his chair, got up too fast, and fell on the carpeted floor.  At eighty-nine years of age, despite exceptionally good health overall, it was enough.

Ambulance, emergency room, multiple doctors, confusion, admission, waiting for surgery.  The wait was mostly because of his blood pressure, which kept going up and down, was dangerously high at times.  This continued even after the surgery, during which they put in three pins.

When we were in Emergency for six-plus hours, we were asked for a complete list of his medications.  Twice.  Then again when he was admitted.  They had also taken the same list when he had been at the same emergency room a few weeks prior for another issue and it was still in the computer.

So, it will come as no great shock to the experienced reader to discover that the reason for the dangerous swings in blood pressure came about because he was only getting two of his three blood pressure medications.  Yes, all three were on the list that we had given them at least three times.

Now the people involved all seem to be competent professionals.  I am not blaming any particular individual.  Yet every time we get involved with the country’s medical – system? – we run into exactly this sort of confusion.  Everybody is  in charge and nobody is in charge.  One specialist orders a change in the program to solve his particular issue and it ripples through the treatment plan in unexpected ways or some shift worker does not hear of the change.

Although they can do some truly amazing things these days, there is something horribly wrong with the way healthcare is organized.  Despite the obvious frustrations of patients and providers, no solution to this problem seems to present itself.  Third-party payment, insurance regulations, and carefree litigation are causing perverse incentives in the system, which nobody can seem to get a hold of.  It does not seem likely that our new nationalized healthcare is going to do anything to solve this problem.

Meanwhile, my father-in-law is doing extremely well with little pain and he is healing well.  I am quite confident he is going to survive this forced incarceration and return to the life that he had before.  When he does, it will be both because of and in spite of this bipolar industry we have all created.

The only way to fix all this is to change the incentives.  To do that, we will have to change the incentives of the ones who create the incentives.  If that makes sense to you.


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