Searching in All the Same Places

April 25, 2019

Eric Postal asks, why does meddling with healthcare so often take the same approach?

Pardon me while I put on my Seinfeld hat, but how do you suppose they came to call it “research”? That is, what’s that “re” about?

“Search” makes sense. You’re searching for answers, explanations, or evidence to support/refute a point of interest. Tacking on that “re” makes it sound like someone (or more than one) undertook this search already, and you’re going to do it again. Why? Did the other(s) do a lousy job? You think you’re better than them?

I hear “research,” and what comes to my mind is the frustrating efforts that go on when something’s missing, and at least one of the folks trying to find it claims absolute surety of where it was. Except it’s not there. Yet, as everyone casts about for the errant item, the absolutely-sure individual keeps coming back to where s/he “knows” the item was. It makes zero sense that, having fruitlessly searched that location, one might go back and magically find the item there after all-let alone a third or fourth time later-but that doesn’t stop folks from re-searching the spot.

Related article: In Politics and Medicine, the Reasonable Guy Loses

Society has laid claim to its usage of “research” for a sufficient period of time that there is zero chance I’m going to repurpose it now, so I’ll live with my version: Re-search. In spoken conversation, I’ll be sure to pause meaningfully so folks know there’s a hyphen there.

If you’re re-searching, you’re searching where you or others have already searched. If you’re the only one involved in the situation, fine; expend your time and resources as you see fit. Otherwise, you might owe some folks explanations. For instance: Everyone is in danger of being late if we don’t find the car keys, and you’re fiddling around in one of the places we already know they aren’t? Knock off the goldbricking and look somewhere else!

Healthcare and politics

The topic came to mind recently because, for a fragment of a news-cycle, the politicos and media were babbling about healthcare being a subject of interest in the 2020 election. Talk about “this is hardly news” headlines, eh? Something that’s been on everyone’s top-5 issues list for the past couple of decades is still there-who knew?

There already being nigh-unto two dozen credible candidates for Prez (and if you want a chuckle, have a look at how many more have actually filed with the FEC to run), so I think it’s safe to say the campaign-season has begun-if indeed it ever ended after last time. I therefore consider every moment that now elapses without chatter about fixing healthcare to be a bonus.

It’s not that I consider the subject unimportant or unworthy of discussion-far from. But, as the years have gone by, I would place most if not all of the treatment of the matter squarely into the category of re-search. That is, looking for solutions where we’ve already repeatedly, if not exhaustively, looked.

The major players-or factions, really-seem to be playing the role of the re-searcher who is absolutely sure of where to look. Except, instead of insisting that the car keys were right here and there’s no point looking anywhere else, they’re insisting that the way to fix healthcare is this solution right here, and there’s no point talking about anything else. No matter how many times their solution has been rejected-by a majority of the citizenry, by entrenched power-players, or simply by the numbers (a la CBO analyses, however fallible they may be).

Just like one of the passengers who needs to go somewhere in a car, I’m reasonably sure that we’re not going to get in it and go anywhere until we find the keys. And we aren’t going to magically find them if we re-search the same spot they haven’t been the last dozen times we checked it. Similarly, if everyone clings to their previously-held positions about fixing the healthcare system, we can expect to have just as little of a solution as we did before.

So, maybe the way to proceed a little more readily than we have is for anybody who wants to be taken seriously to pledge that they won’t re-search this time around. Everybody has to come up with something new-those who don’t can expect to look like they’re still (futilely) fighting the last war.

More from the author: Another Clinical-history Piece…

I don’t claim to have the perfect answer, although long-term readers may remember that I’ve offered a few ideas in columns of yesteryear. One of their themes leaps to mind: Removing some of the middlemen who have somehow managed to impose themselves upon the healthcare system, and indeed established their own stranglehold upon it.

Just like stepping away from the spot where you’ve been re-searching, maybe it’s time to step away from the idea that healthcare needs more involvement from politicians, lawyers, regulators, insurers, and administrators to function properly. Every attempted fix I can recall has brought more of these folks into the picture, eating away at what once used to be a fairly-exclusive relationship between doctors and their patients.

I don’t think we’ve “searched” in the area of removing any significant number of these third parties from the mix. It seems as good as any a time to try.