“We’re in a Low-Growth World. How Did We Get Here?”. http://nyti.ms/2babAnw

It is not news, as Professor Gordon points out in the article  that the “digital” age has not been the driver of “GROWTH” that was expected. In fact, the growth of personal devices helps to gloss over reality in almost every way I can think of.  Since almost everyone seems to have one (or several) we think that economics is NOT the problem!…”after all, look at the growth of these products and all the new things I can do”.

The computer revolution is very much unlike railroads, trans-Atlantic cable, airplanes, and automobiles.  Those inventions and others changed life for nearly everyone and built exponential  GROWTH.  However, the QUALITY measures inside that growth from 1850-1970 remained either unseen or ignored, except during times of social upheavel and social movement.

The time has arrived at long last when we must  deepen a democratic economic vision based on QUALITY of life for all.

Now that would be something to measure!

What is necessary is to build a consensus through democratic means around QUALITY of LIFE for all.  Investments in such an economic strategy would require a re-alignment of the priorities of wealth, require an end to corruption of all kinds, reduce militarism, and re-direct capital flow to health, education, housing, environmental life-saving, and fair taxation.  If we measured the impact not by GROWTH, but by QUALITY, a new social dialogue would emerge.

 

We must change our thinking fundamentally:  the aggregate growth of an economy is almost meaningless unless that growth is clearly defined in the context of quality of life…

I believe there is a grand experiment that we can undertake:  change our thinking about growth:  in the health care sector.

Nearly 20% of our GDP, that amorphous super macro measure of growth hides the quality of that measure:  for all of our highest in the world spending, the World Health Organization ranks the US 37^th in the world in health care outcomes for its people.

A vision known as The Triple Aim summarizes a new vision, a realizable state of consensus in which 1.)each individual, and 2.) the population in aggregate achieves health, and in so doing, 3.) the cost to achieve health is substantially reduced.  There is a growing consensus among stakeholders in the healthcare sector of the economy that The Tripe Aim ought to be achieved.  Obviously there are differences about how to get there…but the vision is demanding and actually quite specific in its intent.  The Triple Aim demands that the nearly 20% of GDP spent on health care be measured, improved, and substantially reduced.

Through Medicare, Medicaid, the Federal Health Insurance programs, the Veteran’s Administration,  and now the Affordable Care Act, we say as a people that care must be extended to all, care that is of the highest quality, highest safety, with gentle and caring patient experience.  If actually achieved, care for all will become much less costly because health is maintained for everyone, not just for those who can afford care.

To accomplish this, we need   systems thinking:   the cost, safety, quality, and access to care requires a different delivery system of care and a different payment system that rewards outcomes as opposed to activity: outpatient and preventive care should be the emphasis, with clinics available near everyone; outpatient care must emphasize early childhood preventive care, including dental care and behavioral/mental health care. We need care that is based on popular education methods so that people learn to own their own health and understand their bodies.

There is a broad consensus that these transformations in health care would if implemented over time, save at least $1 trillion of the $3 trillion annual spend.  To achieve this outcome, we must start the investments in transformed health care thinking and delivery systems as soon as possible.

All of these changes that must take place require a much different dialogue among practitioners, employers, employees, administrators, insurers, government, unions, and community stakeholders.  Inherent in the changed dialogue is a commitment to put self-interest aside, and plan change in a collaborative fashion based on measureable improvement and value creation.

Social dialogue must replace the politics and confrontation of self interest in all venues.

Like anything else, a system that works requires management and regulation:  you cannot have utilities, transportation, or construction of buildings or housing without strict regulation and systems to ensure safety and service. Health care requires the same kind of planning.

Wholesale cuts in expenditures or services are not the answer. Clinicians and providers can only cut their own expenses so much, and these cuts will impact small group and individual practitioners and advantage large systems that can scale back costs through consolidation and volume.  Such cuts will demoralize the workforce, which instead must be fully supported.  It is the workforce that must be fully engaged to solve the problems of waste, error, efficiency, safety, and patient experience.

The Triple Aim envisions substantial reduction of the unsustainable amount of our nation spends and wastes on health care.   The Triple Aim can serve as a very large-scale example of a  fundamental alteration of priorities

Without measures of improvement in our people, we will continue to mask democracy with incomplete and amorphous data.  The Triple Aim is inherently measureable, and should serve as a path to how we think about and measure our economic activity.

This is hard, but it is much harder and dangerous to have a society in which the basics are missing for so many.