David Chapman writes about how he's spent the last year "navigating the medical maze on behalf of my mother, who has dementia." His key observation? The American health-care system isn't a system at all.
Or to put it another way, US health-care no longer demonstrates systematicity. If want to send a package with Fedex, they have an excellent system in place that ferries your parcel from point A to point B. They know what's going on inside their complex system of many moving parts. Fedex also has a simple user interface, which is another crucial property of good systems: To use Fedex, you don't need to call your friend with clout who can "get you in". You just call Fedex.
The health-care system displays none of these properties. It may possess formidable amounts of medical tech, but there's almost no formal information flow, so access to anything requires a doctor wielding mafia-like connections. As Chapman notes ...
It’s like one those post-apocalyptic science fiction novels whose characters hunt wild boars with spears in the ruins of a modern city. Surrounded by machines no one understands any longer, they have reverted to primitive technology. Except it’s in reverse. Hospitals can still operate modern material technologies (like an MRI) just fine. It’s social technologies that have broken down and reverted to a medieval level. Systematic social relationships involve formally-defined roles and responsibilities. That is, “professionalism.” But across medical organizations, there are none. Who do you call at Anthem to find out if they’ll cover an out-of-state SNF stay? No one knows. What do you do when systematicity breaks down? You revert to what I’ve described as the “communal mode” or “choiceless mode.” That is, “pre-modern,” or “traditional” ways of being. Working in a medical office is like living in a pre-modern town. It’s all about knowing someone who knows someone who knows someone who can get something done. Several times, I’ve taken my mother to a doctor who said something like: “She needs lymphedema treatment, and the only lymphedema clinic around here is booked months in advance, but I know someone there, and I think I can get her in next week.” Or, “The pathology report on this biopsy is only one sentence, and it’s unsigned. The hospital that faxed it to me doesn’t know who did it. I need details, so I called all the pathologists I know, and none of them admit to writing it, so we are going to need to do a new biopsy.”(Illustration via the CC-licensed stream of Hucky)