As I See It: The Second Concern
January 23, 2012 Victor Rozek
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Recently, I contacted a number of colleagues around the country to find out what concerns occupy their quiet moments. Not surprisingly, at the top of the list was keeping or, in one case, finding a job. Most reported working for years with no prospect of a raise, and several whose spouses were no longer employed had been forced to make lifestyle adjustments. But close behind employment was the desire to maintain or find affordable healthcare. There is an ironic timeliness to their concern. Every January many Americans try to preempt the need for healthcare by getting fit. After a holiday season of snarfing down rich foods and drinking from the gravy bowl, half-empty gyms fill up as dietary indiscretions are repented and treadmills are pounded with the fervor of ceremonial drums. But the motivation to stay healthy goes beyond the desire to look good and avoid illness. There is a companion desire, as expressed by the people I spoke with, to avoid losing what’s left of their life savings. For many IT professionals, a protracted illness or major surgery would result in economic dissolution. And, sadly, having medical insurance is no guarantee of solvency. Of the Americans who cite medical reasons for declaring bankruptcy, the majority were actually insured. But their policies simply didn’t begin to cover their expenses. Add to that 50 million uninsured, and no one seriously argues that the system isn’t in urgent need of reform. But the demon is in the details, and waiting for a workable solution is like waiting for Godot. In the meantime, the IT professionals I spoke with pay between $800 and $1,200 per month for family health insurance. And the number of companies that offer full healthcare coverage has been dropping faster than Congressional approval–from 74 percent in 1980 to under 10 percent today. Paying for health insurance is like having a second mortgage, but one that doesn’t buy much. If you’re hit by a meteor you’re probably covered, but anything else, you’re mostly on your own. A colleague who has a child born with a severe disability acknowledged that a single surgery exceeded what he makes annually. And those nearing retirement report that in order to keep premiums manageable, each year they are forced to accept less coverage for more money. Everyone shared the fear that a single major illness could ruin them. Most of the people I spoke with believed that a single-payer system–like the ones used with greater or lesser success in every other industrialized democracy–was the only workable solution. A software development manager thought Obama-care would close the gap for the uninsured. But the most unexpected remarks came from an unemployed Seattle-based medical systems analyst. She told me about a visionary physician who was on a mission to remake the medical system. The good news, she said, was that change could be achieved with compassion but without collectivism. The bad news was that, if it worked, more than a few IT jobs would be lost. The physician in question is Dr. Pamela Wible, a 40-something curly-headed dynamo who just a few years ago wanted nothing more than to quit medicine and become a waitress. At fault was what she describes as the “factory system” of healthcare delivery in which physicians work. It is, she believes, a system that is dehumanizing to both doctors and patients. Typically, doctors see up to 30 patients per day; an endless assembly line of ills where faces and aliments blur, and the complexities of the human condition are reduced to a few notes on a chart. She was exhausted, dispirited, and wanted to quit. And she was not alone. Of 12,000 primary care physicians recently surveyed by the Physician’s Foundation, 78 percent believed that medicine was either “less rewarding” or “no longer rewarding.” More than three-quarters of doctors report being “overextended and overworked.” Empathy burnout is common after seeing 10 patients a day; most doctors see three times that amount. Nor was the factory model economically rewarding. Medical centers with waiting rooms, receptionists, nurses, billing and IT departments, create huge overhead. Wible’s overhead was a whopping 74 percent, which equates to the first 22 patients seen each day. In order to make a living, it was impossible to slow down, she says, much less listen, or think, or even care. Wible wanted a practice based on human relationships, one where spending time with patients was not considered practicing alternative medicine. Her solution was to hold a series of forums in which she asked her community to describe their ideal medical practice. She collected over 100 pages of testimony, which became her business plan. Not surprisingly, people wanted to be treated with dignity, not like a commodity. They didn’t want to be asked for their insurance card the moment they entered. They wanted a doctor who listened empathetically and observed without judgment. A doctor who would interact with them and take time to really get to know them; a doctor who is available by phone. They wanted a physician who would not turn them away for lack of insurance. No waiting in sterile rooms that have all the warmth of a bus station. They wanted couches instead of chairs, soft music and indirect lighting. One person asked, “Would it be too much to have a doctor who is happy?” Wible designed a patient-centered clinic. She got rid of the overhead, and now also functions as the receptionist, nurse, bookkeeper, insurance biller, and janitor. Every patient gets an hour-long appointment. If she has to refer them to a specialist, she will often accompany them. About 80 percent of her patients have insurance, and she will barter if a patient is unable to pay. No one is turned away for lack of money. By choice, she works part-time and makes more money than she did when she saw 30 patients a day. The rest of the time, she travels the country helping burned-out doctors rediscover their passion for medicine and transition from a factory system to a patient-centered practice. Undeniably, should doctors begin doing their own billing, some IT and clerical jobs will be lost. But in exchange for quality, affordable healthcare few, I suspect, would complain. We are all stakeholders, because whether through accident or attrition, at some point, each of us will become gravely ill. And from my conversations with colleagues, that prospect is the cause of considerable uncertainty and chronic concern. It should not be so. As a nation we spend an unfathomable $2.2 trillion annually on healthcare. Yet we are far from healthy. Forty percent of us are obese, and heart disease, diabetes and cancer are rampant. As one programmer told me, “When you’re most vulnerable, it’s a bad time to get thrown under the bus.” I share this because, whether its medicine or IT, or any other endeavor for that matter, the same principles that guide Wible can remake the way we conduct business and, by extension, treat one another. The agent of transformation is the simple act of putting people first. Won’t work, you say? I know it does because I work for a man that employs these same principles here at IT Jungle. His is a business built on relationships. Through good times and lean, he does what he can to put people first. January is a traditional time for optimism, and I can think of nothing more hopeful than evidence that people can succeed and effect change by swimming against the current. As institution after institution is unmasked as vulturous, it’s comforting to know that the most ruthless predator need not always triumph. In the words of Doctor Pamela Wible, “The winner at the end of the day should be the best humanitarian, not the person who hoarded the most money.” Amen.
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