Why “House” is the True American Health Care Hero, And What To Do About It

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.

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4 Responses

  1. Ken Rhodes says:

    Good grief! Trying to make an important point, you weaken your case with an absolutely awful strawman.

    Have you ever actually watched a complete episode of “House, M.D.?” In nobody’s wildest imagination is he or his medical function in the hospital remotely related to cohesive, forward-thinking planning, or coordinating patient care.

    From Fox TV’s description of their award-winning a popular show: “House is a brilliant diagnostician whose unconventional thinking and flawless instincts afford him a great deal of respect. An infectious disease specialist, he thrives on the challenge of solving medical puzzles in order to save lives. House shepherds an elite team of experts who help him unravel diagnostic mysteries…”

    A diagnostician whose role is to solve diagnostic mysteries.

    In the world of perfect medical practice, there will still be mysteries, and they will still need Sherlock Holmses to solve them. Why in the world would you toss in this silly distraction to clutter up an otherwise on-point criticism of the way our overall medical care is FUBAR?

  2. Vickie Williams says:

    I have indeed, watched many full episodes of “House.” And that is my point exactly, that what makes House so amusing to watch is the lack of cohesive, forward-thinking planning, yet his brilliance and acumen are revered by his fellow physicians (even though his personality is not), and ultimately, rewarded. In a cohesive, forward-thinking health care system, more patients would probably die because of people like House than would be saved, and he would not be allowed to behave like the Lone Ranger.

  3. Frank Pasquale says:

    I like the way you have explored some popular archetypes of health care quality. House is an outlier who deals with outlier cases, and too many people assume that this is the highest and best form of care.

    By contrast, I was at a conference at BU a few weeks ago where I saw presentation by a company that just aimed to make already cheap diagnostic tests cheap enough to be afforded in the developing world. They are succeeding on many fronts. That sort of dedicated, incremental improvement in access is going to do a lot more for people than the occasional flash of genius lionized on House.

  4. Vickie Williams says:

    Frank – It does seem that we equate the ability to handle outlier cases with good health care, even if it comes at the expense of basic health care for a greater amount of people. Sometimes I think that people are like parakeets when it comes to health care and technology, entranced with the new, shiny toy regardless of whether it adds anything to the repertoire in the birdcage. The type of work that the company that you saw at BU is doing is where we need to focus more of our health care resources.