The healthcare squeeze
Strong emotions become our first thinking point.
People think first with their emotions
You’ve been in that moment when fear, anger, or joy outpaces your ability to manage its expression. Maybe it’s a spider that drops down right in front of your eyes, seemingly out of nowhere. Or somebody cutting you off and nabbing the only parking space in sight, or the utter joy of your favorite team winning in overtime. Somewhere, sometime in your life emotions outpaced control, and while it’s super tempting to scamper down that rabbit hole in geeky glee, all we really need to remember at this time, with this project, is that emotions can short-circuit our thinking.
Especially when they are powerful.
You’ve been sick. You know what feeling wretched is like. When you were five, you probably cried for your favorite caregiver, snuggled with the family pet, or surrounded yourself with soft blankies and pillows.
Poor health sparks desperation. Desperation has facets of fear and anger. This can start as soon as a body feels run down, because we know that nothing in our lives can stop for this: we have to keep working to earn and pay for all the things our paychecks support. More than anything else, fear and anger makes us easily swayed.
Tell your five-year-old self that a cookie will make you all better, and chances are you’d believe and snarf down that cookie faster than you could say gimme. Tell your adult self that a cookie could make you feel better, save your job, save your relationships, and can be relatively quick: cost is a negligible part of the decision making process. You’ll eat that cookie even if it’s expensive and not the right cookie, in hope and desperation.
Set this against the economic environment in healthcare in the past fifty years.
Our fear of even worse financial burden helps us accept the current financial burden of increasing cost of health insurance — and accept losing those who can’t bear it. The prices will continue to increase; insurance is a business, and focused on profit.
We would have never accepted price opacity without an underpinning of desperation, skewing our perception with an overwhelming, specific goal: end the distress.
When we are sick or dying, we are more likely to take any solution on offer — any cookie. A business intent on wealth building as their primary goal is going to leverage that. They are simply harvesting against demand.
Wealth builders have emotions, too
Desire is a strong emotion, anchored in a future-sensed wish state. Again, it’s really tempting to dive in geeky glee down that rabbit hole. But really all we need to remember is that desire exists, it’s strong enough that the control of it’s action is a central tenant in many religions and laws, and it’s in play when people are wealth building.
People tend to keep on keeping on when desire is engaged and traction has been found. When that desire is as potentially far-flung as the decades it can take to accumulate wealth, that’s a lot of repetition. Decisions made in near-disgust early on are now just…normal.
The basis of attaining wealth is deeply logical and intricate. The basis of gaining wealth is almost all emotion: it’s a heady dopamine rush. In wealth building, a person can be just as emotionally desperate as a sick person, but with different sources and release points. Where logic and emotions converge, forces start leveraging what exists to push forward what they want. That adaptability and problem solving is actually one of our greatest strengths as a species when it’s used ethically.
But at its worst? In the chase, especially for hegemony, questionably ethical decisions can be made. Information will be hidden for various reasons, and bully tactics used to stake out abstract territories. The force lines in the above model are from an analysis of some of what’s happened already when illness is considered a profit center (last section of Increasing costs of healthcare).
The accepted behaviors around money and the cumulative effects of the decisions made in the name of profit are heightening the healthcare squeeze. It’s not the totality, but enough to heighten the pressure, and it’s in the process of normalizing.
Each side of this coin is a harder thing to name reasonable ways to manage in the current landscape. It is emotionally driven, backed by which side of the healthcare-as-a-tool prioritization someone lands on: is healthcare a tool to help people stay and get well, or is it wealth opportunity?
One way around this emotional matrix is to reframe the tool decision point. Since this has been the discussion framework for over a hundred years, it would take creativity and blunt honesty to work around cognitive bias and be believed that you were successful with it.
Another — even harder — way around would be to reframe our wealth narrative.
This is part of Deconstructing US Healthcare.
