My father, a CPA and an attorney, used to tell me, over and over and over again, “You get what you measure.” This is an accounting adage that refers to the fact that the company that focuses on gross sales may get huge gross sales, and yet no profit. If a company focuses on profit, they may make them, but at the expense of growth. You get what you measure.
I recently spent a good deal of time in an airport restaurant surrounded by doctors returning home from a convention of some sort. One thought struck me as I listened to their conversation – “These are not professionals.” When I was a child physician and attorney were considered the highest of professions. And yet these conversations were not learned men discussing the limits of knowledge in their field and how to advance it. They were not discussing how to save more lives or invent new techniques. They were discussing insurance coding and receivables timing. They were discussing procedures for insurance filing and how to maximize payment. These were clerks, not professionals. They were not exercising judgement based on a great reserves of knowledge and expertise, they were trying to figure out their place in a vast bureaucracy.
Physicians are no longer professionals, they are ordinary labor in an immense third-party payer system of which Obamacare represents the acme of current evolution. This system and thinking did not start with Obamacare, but it certainly represents the pinnacle of such an approach in the United States.
Think about the much discussed second nurse. Clearly her professional judgement thought it might not be a good idea to get on an airplane, or else she would not have called. But trained and paid by the bureaucrats, when they told her it was OK to fly, she flew. The narrative around the Ebola crisis is not one of the valiant professional seeking to control virulent disease, rather it is one of protocols, procedures, and systems. It is the narrative of a bureaucracy, not a profession. It is the narrative of how Obamacare handles a health crisis, not how professionals would.
Obamacare has set the measurement for medicine – procedures, codes and protocols, and that is what we have gotten. It currently appears to be failing us.
Lest the reader think I have left the religious roots of this blog in the dirt, there is a religious tie-in. Christianity represented something quite unique from Judaism. The Judaism of Christ’s time was a system of rules, procedures and protocols to achieve goodness. Christ came and preached a message that goodness cannot be achieved merely by following the rules, but that real fundamental change in a person has to happen for the rules to even have a chance. How that change happens is supernatural and too theological for this blog, but the idea is remarkably parallel to the difference between labor fitting into a system and a professional. Labor tries to follow rules and procedure; a professional uses his or her judgement which has been developed through education and experience.
Leaving faith behind as our nation “advances” is having consequences far beyond simple moral decline. Absent the predominant Christian thought that founded the nation, we no longer think in terms of individuals reaching their highest potential, we think of the rules and procedures for each individual to achieve their place. In this case, because we have turned medical professionals, everyone really, into mere labor there are simply too many moving parts for the system to respond with the speed it needs to in a crisis like this.
You want someone to blame for the Ebola crisis? Blame modern areligious thought and the Obamacare it has wrought.