Obamacare: Healthcare’s Own Journey Through Wonderland (Part 2)

Rich or poor, without your health, you have nothing. Perhaps that’s why the business of healthcare, almost 20% of America’s GDP, has been given a pass on the capitalist model of business practice. No other business has thrived without some level of price transparency and a promise of quality. However, with the passage of the Affordable Care Act (ACA), healthcare’s pass on capitalism has been rescinded. No longer are doctors and hospitals going to be paid on numbers alone. “Value” is required. As covered in my last post, this change in the business model has left many in healthcare as dazed and confused as Alice in Wonderland, but there is a way out of the rabbit hole.

That way starts with fundamental changes in culture supported by a new roadmap for technology Let’s start with the culture.

The Physician as Superstar

Physicians shouldn’t try to be Michael Jordan. Good care is a team sport not a game of individual achievement. For those of us physicians who came of age being told we’re special, this requires a reset of our world view. That’s not to say that someone, typically a physician, will continue to be in charge, but rather that roles need a reset. Effective care requires that all providers (nurses, generalists and specialists) have a role and are interconnected.

white rabbitThe Time and Money Equation

Time does not equal money. Most of the time, the more expensive a purchase, the longer we think about it—except in healthcare. In order to optimize physician time, expensive tests are often ordered before the doctor and patient even meet. The cost of care rather than the optimal reimbursement per hour should be rewarded.

Value Versus Revenue

Value does not mean revenue. Historically hospitals reward physician producers, often busy surgeons or specialists, even when outcomes are subpar. New levels of accountability and transparency based on outcomes should be visible to all.


Don’t be right; be reasonable. Americans expect perfection from healthcare. As a result, physicians practice in fear of making a mistake. The end result is a system where extra risk (extra biopsies and surgery), worry (you could have cancer) and cost are passed on to the patient. The pursuit of perfection is it’s own vice. Instead, medical education and standards should enable the individual care providers to be reasonable. My suggestion: hospitals should decide on standards and stand behind their physicians if these standards are followed rather than requiring physicians to stand alone for their decisions.

With decades of tradition and socialization to overcome, these cultural changes face an uphill battle. However, the alternative—the declining doctor-patient relationship—simply isn’t acceptable. Patients often feel adrift in their time of need and doctors are under siege.

A change in culture will move us in the right direction, but it is only the first step. In the final post of this three-part series, I’ll suggest an IT roadmap to codify some of these changes.

Who knows? Like Alice, we may yet wake up in a sane world after all.

Reader Interactions


  1. Hard to imagine that things will change UNLESS the patient has more “skin in the game” by paying more of the costs directly and we get rid of “pain and suffering” damages in malpractice litigation. As long as 3rd party payers continue to be the major direct payers of healthcare costs the average patient is simply not going to be cost conscious enough to impact the increasing costs. Also it seems hospitals were always stating that their costs were so “high” because they had to pay for uninsured patients. Now that we have obamacare and therefore should have less uninsured patients at hospitals I am not aware of any hospital lowering their costs.

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