After reading their article “The U.S. Health Care System: A Product of American History and Values,” it struck me that David W. Johnson and Nancy Kane described exactly why the devious, unethical, but brilliant physician “House” would be the perfect depiction of a health care hero to many Americans. Johnson and Kane explain how the American health care non-system is a product of the value Americans place on self-reliance. This has created an individualistic culture and a view that health care is an individual, rather than a collective responsibility. Couple this with the American preference for markets rather than governments to solve problems, and you get the fragmentation we have now.
In America, physicians are recognized and rewarded for being “the best” (i.e., the most specialized, or the most “brilliant”) rather for collaborating to achieve the best outcomes. Couple this with a health care finance and delivery system that is the product of years of crisis management, rather than any cohesive forward-thinking planning. You put all of these things together, and you get – – – House.
The irony of this is that the actor who plays House on the series, Hugh Laurie, is British. The British health care system was established shortly after World War II with an eye towards ongoing health management of an entire population. A system like Britain’s would not reward or idolize House for his anti-social, egocentric behavior; it would reward him for good patient outcomes (which would make for boring TV, but good medicine). If House spent less time performing his egocentric, lone-ranger-like antics and more time coordinating patient care with his far-more-dedicated-than-him team of doctors, his (and the team’s) rewards would be much greater.
This is not to say that there are no egotistic, self-important health care providers in countries with centralized health care systems. Nevertheless, if the incentives don’t reward that kind of behavior, and the society does not place high value on individualism above outcomes, at least it wouldn’t be encouraged. As Johnson and Kane conclude, the current recession, coupled with increased globalization, have given us a unique opportunity to redefine our core values and align our health care system with those values. We can use models from other countries, but maintain a uniquely American perspective, reflecting the best of American creativity. Economist Richard Florida, in his recent book “The Great Reset,” posits that times of great economic upheaval are also opportunities for innovation. This is as true in health care as it is true in technology or any other field. If we want world-class health care for all, we cannot remain prisoners of the accidents of history that shaped our current health care system.