Benjamin Franklin wrote that democracy is like two wolves and a lamb voting on what to have for lunch; liberty is a well armed lamb contesting the vote.
Hospitals and the government believe that the best way to improve the quality of healthcare is to have more collaboration between physicians and hospitals. But, of course, they’re not simply talking about working collaboration, they’re talking about financial collaboration. And of course, the hospitals want to be in charge of the purse.
So we have our two wolves and we have physicians, the lambs, deciding on the best way to allocate scarce resources.
Of course there’s a bit of a jump in logic here and that’s because there’s no reason why greater collaboration between physicians and hospitals requires economic collaboration at all.
After all, one of the sentinel events in our business lifetimes has been the change brought about by the invention of the microchip and the ensuing technological advances, all of which have served in our economy in general to break down bureaucratic structures due to the increased ability of individuals and small enterprises to compete and for entrepreneurial activity to coordinate across the membranes of separate business organizations as the results of computerization and related technology.
But to believe the government and hospitals, closer financial integration and closer business integration is what is required in order to deliver quality healthcare.
Of course this is a lie, an attractive lie to be sure. What it’s really about is power and control.
Physicians should be all for collaboration in terms of patient care, collaboration with other providers and collaboration with facilities.
But hospitals should play a very small role in that they are, to a large extent, dinosaurs of an earlier era in which close physical proximity and bureaucratic structures were required to compete.
If there are to be collaborative care structures, they should be physician-centric, but this will only happen if the lambs are well armed with knowledge and with political organization and expert assistance.
The two wolves have voted to have lamb for lunch. You are on the menu.