The re-framing necessary to move away from talk of health care death panels

October 23, 2013 | By | Reply More

Here’s another excellent and succinct analysis by Dylan Ratigan, part of an mass emailing he recently sent out. Allowing conservatives to argue about “death panels” is a big mistake and here’s why — and BTW, the time to make policy is not as we gather around very sick people challenging each other as to who can spend the most to to extending someone’s last breaths by 3 months, bankrupting healthcare in the process. We need to grow up and get our heads out of fantasy-land. Let’s redefine healthcare in terms of sustainable and meaningful goals. Ironically, there is date that those who claim to be most confident in the existence of an afterlife insist on the highest rate of last-minute desperate expenditures. Here’s Dylan’s email:

Dear Friends,

Generally speaking, there are only two ways to earn money.

1. Charge a fee for goods or services.

2. Charge a mutually agreed upon percentage based on a future outcome based on the newly created value. This percentage can be in the form of equity or commission.

As it stands, healthcare in America is based on the first model. This creates a system with many, high fees generated by acute and traumatic care. The chart above, from this report by the International Federation of Health Plans, shows how much we are paying compared to the rest of the world:

In reality, this care is for only 5 percent of us at a given moment, yet accounts for 50 percent of what each of us spend on the service regardless of whether or not we are using it.

If this unfortunate reality upsets you, please relax…close your eyes….and imagine for a moment a healthcare model that uses the second model of income generation. One that is based on equity or commission based on a future outcome.

Back in the waking world, we must acknowledge that the barrier preventing the use of such a model is the lack of a mutually agreed upon “value proposition” between patients, doctors, medical device sales people and hospital administrators.

The value proposition I would like to put to all doctors, mine included, is as simple as it is impossible: Don’t let me or anyone I know die.

The results of this value proposition is a state-of the art traumatic and acute care system for which customers will pay any price. Because this system is shaped by the question, “How much would you pay to not die?”

This is what we have, and it is impossible to sustain.

As a result of our healthcare system based on the wrong value proposition, we have Democrats and Republicans pushing the country into an obviously insane shutdown over healthcare. To them, it is all a fantasy battle based on competing visions of “Don’t Let Anyone Die.”

So what if the value proposition was equally simple but absolutely possible: Help me, my family and friends live long and prosper.

Instead of “Financial Death by Itemization,” I will pay for increased health. Healthcare professionals become what they desire to be most of all; partners in the health of patients instead of unwitting profiteers on acute sickness and emergency medical treatment.

This system aligns interests with healthcare and life instead of healthcare and not death (and if you don’t believe that aligning interests is in our best interest, please check out this report on ACA from Media Trackers).

In theory, a transparent national insurance pool could fund a salaried healthcare workforce from top to bottom. Out of the transparent national fund, our healthcare workforce would be paid bonuses tied to the wellness of their patients, including “non-sick” days and improvements on key health tests.

This is pure imagination but it brings to light one of the key components of our deeply flawed healthcare system; that it is powered by an unsustainable, high-cost, fee-for-service oligopoly finance engine.

This model is perfect for the impossible fantasy based on Don’t let me or anyone I know die.

I propose the way of Spock that is, dare I say, more logical. Let’s try to simply Live long and prosper.

Onward and upward,


I’ve included a link to the chart Dylan mentions.


Category: Health Care Reform

About the Author ()

Erich Vieth is an attorney focusing on consumer law litigation and appellate practice. He is also a working musician and a writer, having founded Dangerous Intersection in 2006. Erich lives in the Shaw Neighborhood of St. Louis, Missouri, where he lives half-time with his two extraordinary daughters.

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