Its All About Mom ... editorial
After looking at the results of our patient survey and the new data from the AMA on the failures of HMO's, I've come to the conclusion that the best way to look at our faltering health care system is to visualize it as one big dysfunctional family.
We have the hard working but clueless Father (The health care purchasers, usually the employer) who is so busy trying to make ends meet that all he has time for is his work. He doesn't know where the money goes, but he does know there is never enough. He hands his paycheck over to his wife, the Mother (the insurance company) who is a severe alcoholic and probably Bipolar, but attempts to conceal this from him. Or, like so many dysfunctional families, he just doesn't want to see it. When the Father complains, she blames their financial problems on someone else. In our case it is an easy target, poor Uncle Ned (the pharmaceutical companies) who gets blamed for everything.
Of course in a dysfunctional unit there is always someone who holds things together. In this case it is the older sibling (the physician), who being the responsible enabler that he is, hides Mom's problems, does her work for her, and maintains his role as care-giver to his younger and vulnerable sister (the patient), while trying to keep Dad happy as well. Although clearly a dysfunctional relationship, as long as everyone maintains their role, especially the enabler, things will continue to function. The one fiction that everyone must perpetuate is that "things are okay." Lots of energy and money are spent maintaining this fiction.
All the while, Mom continues to drink up the finances. The older sibling protects the younger sister by getting another job or going without food to preserve the perception of normality. As Mom sinks farther and farther into her pathology, her one-time nurturing function is almost forgotten. Her abortive attempts to help the family (HMOs, Preauths, PBMs) often ill-conceived, and with mixed motives, only create more difficulties. Again the job of cleaning up these messes falls to the care-giver, who as a good child, takes each suggestion earnestly then suffers through the consequences like a martyr.
Now the schemes from our dysfunctional Mother are coming faster and with such a sense of desperation that I suspect the health care system, like most dysfunctional families, will eventually collapse.
It is the classic soap opera. The family has it all--the most powerful and wealthy country in the world struggles with its dysfunctional health care system while the rest of the first world enjoys universal health care-- yet everything imaginable happens to it. Why, one can just imagine turning on the T.V. to the promo.
"Today on All My Healthcare Children": A zoom in close up of a aging but beautiful woman with perfect hair. "Jonathan, I can change, I promise. If we only had electronic medical records and electronic prescribing we would be okay. We would be all right," she pleads.
The husband, who is handsome and with perfect hair, can only look back in distress. She moves closer, wobbling slightly.
"If . . . If we could just have Pay for Performance and Quality Assessment, we would be a family again. It won't be any trouble, I promise. "
The camera pans to the son whose face changes from pity to disgust to anger. As the promo ends we hear Mom on the phone ordering more Vodka from the liquor store.
We realize that Mom will never change, that only the son can change the situation but he probably won't. He is the care-giver, that is all he knows to do. It's all about Mom.
Happy Mother's Day,
Cody Wasner MD
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