The tragedy of the commons refers to a dilemma described in an influential report by that name written by Garrett Hardin and first published in the journal Science in 1968. The report describes a situation in which multiple individuals, acting independently, and solely and rationally consulting their own self-interest, will ultimately deplete a shared puny reserved supply even when it is clear that it is not in anyone's long-term interest for this to happen.
This concept is at the heart of Donald Berwick's view of American Healthcare, and it is vital to insight and simplifying the incredibly dense language he uses to relate his plan.
Kaiser Medical
I wouldn't come out and say he is lying, as he is not, but he has made the entire issue so complex, using specialized language, that it is hard even for medical professionals to understand.
As I have been discussing in my blog posts, the emphasis in American healthcare, given by specialists, is to maximize the benefit to the private patient. Treating them to the maximum extent inherent by money and technology. I have also shown how all many personal, pro and financial incentives align to make such rehabilitation beneficial to the doctor. The inpatient also regularly benefits, by living longer, as Americans survive longer with multiple diseases as compared with most other countries.
However, this relatively small increase in survival costs far more than other countries, money which must be diverted from other areas, both in and out of healthcare. That is the "tragedy of the commons", where the allinclusive health of the citizen may be worsened by laberious rehabilitation of the most ill.
Berwicks goal is to reallocate the way in which care is delivered, to sell out the amount given to any private patient, reducing costs. The language will be difficult to understand. Concepts like "best practices", emphasis on "primary care and prevention", "heath information technology", "integrators", "measurements" etc. Which are undoubtedly code words for changing how care is delivered.
The lowest line is that decisions will be taken out of the hands of the specialists who are now manufacture them, and given to panels that make decisions on a national level. Alarmist politicians accusing Obamacare of having "death panels", are undoubtedly talking about such national decision manufacture bodies. The accusations do have a grain of truth, in that healthcare for the individual, particularly the very sick one, may be curtailed, and some citizen may die after being denied care. However, by diverting some of the resources previously used to treat the dying to prevention, healthcare may get much better for the citizen as a whole. If Berwick has his way, the entire country will come to be like Kaiser healthplan. It will be great care, until you get sick.
I will talk more about some specifics to expect in the next few blogs.
helpful site Healthcare As A Tragedy
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