Homelessness. The opioid crisis. School safety. Healthcare access. We see the tragedies – lost lives, shattered families, communities in crisis – and decry the systems that created them, but remain so focused on finding a “magic-pill” fix that we fail to make any meaningful change.
Consider, for example, the concept of universal healthcare – or, more specifically, a single-payer healthcare system, currently one of the most popular proposals for achieving universal coverage. There are ample arguments for and against, but for the purposes of this article, imagine we woke up tomorrow to find a perfectly instituted single-payer system, working exactly as intended by proponents, with none of the shortcomings or problems commonly cited by critics.
What would it look like? For most basic and preventive healthcare, all citizens’ medical bills would be paid for out of a single government-run pool of money. Simplified billing would mean medical providers’ administrative time and expense would go down, allowing them to see more patients. The leverage of a single payer would reduce and standardize rates paid to providers, pharmaceutical companies and device manufacturers. In short, it would streamline the complicated existing structure of healthcare reimbursement, giving more people more direct access to basic care at a lower overall cost.
At a minimum, this would achieve something important that our current system does not: widespread access to care. But would it result in significantly greater community health? Better, more compassionate and holistic care of individuals? Happier, more balanced medical providers?
I do not believe that it would – at least not without other significant changes to the way we practice and pay for medical care in this country. Because while a single-payer system would provide healthcare coverage for more people, it would do nothing to improve the effectiveness of that coverage. We would still be operating within a hierarchical, activity-based reimbursement structure that is only effective if problems, providers and communities are uniform and predictable.
Humans just don’t work that way.
Our bodies, our brains and our social systems are complex, and outcomes in complex systems are a moving target – the result of interdependent and continuously changing and adapting network interactions. No single change will “fix” the system because no single element in the network affects all others equally or statically.
For our own well-being, we have to let go of the idea that complex, adaptive systems – politics, healthcare delivery, education – can be adequately managed by solutions designed for complicated but relationally static systems. Our culture simply does not function like a production line. A community is a dynamic environment in which every member is unique, and we will make no progress by continuing to simplify and reduce them into over-generalized “populations” to be managed by manufacturing management theories.
Rather than looking for a cure-all, it’s time we recognize the complex, interwoven nature of our social systems and accept that incremental change is the only solution, not a lesser solution. We must embrace and act on localized, networked approaches to continuous improvement rather than focusing solely on single-track proposals that make great headlines and political trail talking points, but fail to actually address our personal and community health.
Does that mean we should abandon the idea of single-payer? Not necessarily. But we should view it as just one part of a complex and ever-evolving network organized around the common purpose of improving community health.
Systems thinking shows us the path to a model that will allow us to deliver more and better choices for providers and patients. Using technology to help us map real-world community health networks, observe how those networks move and identify what does and does not deliver desired outcomes, we can restructure healthcare delivery as a series of self-organized networks capable of adapting in real-time to meet the true needs of each point of care.
This new approach is not a tidy, sitcom solution to the question of how we fix our healthcare system, but embracing the complexity of adaptive networking can empower each of us to make the changes we can, when we can – and watch as the impact ripples and grows.
Michael D. Rohwer M.D. is the Executive Director of Curandi. He can be reached at [email protected].