Socialized Medicine – an Evolutionary Approach

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Accountable care organizations.  Patient centered medical homes.  Episodes of care.

What do they have in common?

They each attempt to use payment incentives to encourage disparate practitioners to collaborate to achieve quality outcomes.

A common purpose

Socialized medicine is progress

The key word is collaborate.  Countless research indicates that when doctors work in teams, they achieve better results at lower costs.  It is this transition from doctor as solo practitioner to doctor as a member of a team that is the key challenge to reforming our health care delivery system.

This transition from solo craftsman to a member of a team is not new to the evolution of our economy.

It is how Karl Marx differentiated capitalism from the mercantilist economy that preceded it.  He called it the socialization of work.  It was this contradiction between the socialization of work and the private ownership of the means of production – capital –that was supposed to be resolved by the socialist revolution.

Karl Marx recognized that this socialization of work brought tremendous increases in productivity to the world economy.

The socialization of medical practice can improve the efficiency of health care delivery in the United States in the same way.  It can deliver better outcomes at a lower cost.

It is more than ironic that this feature of capitalism, the socialization of work, is criticized as if it is bringing this country closer to socialism.  If that is true, then the same critique could be leveled against Henry Ford’s assembly line.

Socialized medicine makes docs happy

There appears to be a key difference.  Marx argued that when the worker was separated from his own means of production he would be unhappy.  Marx called it alienation.  It was this alienation that would lead him or her to the path of the socialist revolution.

Doctors are not happy campers now.  The Washington Post reported on a survey of 119 clinics in which one-third were unhappy enough that they were likely to leave their jobs within the next two years.

But when doctors are working in a “medical home” they “turn frustration into excitement”.

The transition from piecework to team work is the key.  It is a transition away from a revenue focus to a focus on health outcomes.

Evolution as Revolution

Revolutions are not always sudden, violent and disruptive.  Revolutions can evolve.

The Patient Protection and Affordable Care Act provides for numerous pilot programs to encourage the development of patient centered medical homes, accountable care organizations, and the use of episodes of care.  These are not drastic measures.

They are intended to stir the pot to simulate the evolution of a more accountable, patient centered focus on health care outcomes.  The key ingredient in all of them is collaboration – the socialization of health care work.

If they succeed they will have achieved a revolution.