1.  No jobs

2.  No money

Now your particular issue might be education or terrorism or energy or even too many taxes, but I assure you all of them fundamentally are a fact of "no money."  Until we get in a sustainable fiscal situation, your pet cause will never get the resources you think it needs.  

An item caught my eye in Saturday's paper that has, at its heart, the answer to all these issues.  It was titled: "Study of Breast Biopsies Finds Surgery Used Too Extensively."  Huh?  Bear with me.  

At the core of our jobs and fiscal situation is one simple fact:

Healthcare is eating into all of our economic activities.  The simple fact that healthcare costs are outpacing wage growth at this alarming rate ensures a number of things.  One, any business with employees (all of them!) is getting more and more expensive to run with no increase in output.  Two, any society that plans to take care of the health of its elderly or indigent has escalating costs that will eventually be unsustainable.  Three, anyone who needs healthcare (everyone!) needs more and more wealth just to stay in the same financial situation.  This is a recipe for disaster.  If you look at our budget issues (state or federal), I assure you if you fix healthcare costs, you fix the budget.  Take education.  Every single school teacher's healthcare rises 3x inflation each year.  That is a huge cost that means fewer teachers, no salary increases, and more red ink.  And as far as businesses go, well, each employee continues to cost more and more (without salary increases) crowding out hiring and new investments.  

Entitlement reform is about WHO pays for healthcare.  Even if you move the current public burdens off the government onto private individuals or businesses, the economic headwinds are catastrophic.  

We have to solve this problem, and I am increasingly convinced it is not only possible, but not that hard.  Which brings me back to Breast Biopsies.  

If you read the article you will see data has proven that 300,000 more surgical biopsies are being conducted than should be.  The result: over a billion dollars of extra cost, more complications for patients and no more information about diagnosis than could be obtained with the less expensive method.  This is pure economic waste.  Over a billion dollars of it.  For one procedure.  One of thousands in the healthcare industry.  

This example is at the core of how we fix healthcare.  We treat it as an industry that has accelerating returns.  One that can get cheaper AND better.  It can.  We just need to get totally focused on fixing it.  Arguing about WHO pays is not nearly as important as WHY we are paying so much.  Here are a few steps (of many) in my mind to turning the tide:

1.  Admit we have a problem.  We spend more than 2x per capita than other advanced economies on healthcare and get no better results.  This does not mean we have to copy these other systems, but our system is generating a terrible return on investment.  Admit it.

2.  Apply Moore's law thinking.  Returns accelerate where information is the key input.  Healthcare is just such an industry.  We need systemic ways to generate and apply learnings just like the biopsy example.  This means accepting that doing the cheaper thing can be the best thing - in fact it means if we are not lowering costs and/or improving results we are failing.  This is a huge shift in mindset.

3.  Data, data, data.  We need data standards, data rules, even ways for patients to share data with researchers.  Information is the key to insight and right now it is way too hard to collect data, store it, mine it, and share it.  There are huge opportunities here - for government, insurance companies and even entrepreneurs.    

4.  Reshape our view of the doctor.  We tend to think of doctors as demigods.  Well trained experts making tons of judgement calls uniquely within their individual power.   But doctors are much more like airline pilots.  They require a ton of special training to do something that 99% of the time is predictable.  Their real value is applying judgement in those other 1% of cases.  Unlike pilots however, the information and technology applied in healthcare is highly dynamic (akin to a new plane coming out weekly).   We have to get this data to doctors and ensure they act on it.  Will the information about biopsies translate into action that gets lower costs and better results?  There is not an easy way for it to happen throughout the system today.

5.  Tort reform.  Mistakes are predictable in healthcare.  They are a cost of a highly complex system.  We need to create an efficient way to deal with them.  Like workers comp, many such models can be easily applied.  The real cost of torts in healthcare is not the actual damages, but the wasteful medicine applied to avoid them.  We need a more balanced system if we want to avoid statistically ineffective treatments.

6.  Hot spot focus.  Healthcare has 80/20 dynamics.  A few spots drive a large percentage of the waste.  The surgeon Atul Gawande has written persuasively about the high costs of the chronically and terminally ill.  If we start here (a targeted place to direct data needs and better decision making), surely we can start to show the power of new models.

Of course there are many many other issues to tackle - the role of insurance companies, doctor and patient incentives, and so on.  It will take some big and many small changes.  

Why are we not moving down this path?  There is bi-partisan blame to go around.  But, it has to start with voters and patients.  We have to realize and accept that healthcare can get better and cheaper.  We have to be open to policies that have at their core cuts in medical costs (but not drops in effectiveness).  At this point, if we don't, expect our big problems to stick around a long time.