Is Covert Rationing a Vast Conspiracy?

Posted on June 5, 2007
Filed Under An Introduction to Covert Rationing |

On the surface it might seem impossible to conduct widespread rationing in a huge industry like healthcare, which consumes nearly 15% of the GDP and directly affects the lives of most of us at one time or another, and to do it covertly, in secret. Wouldn’t the rationing of such a highly visible commodity be apparent to everybody?

Actually, it is quite apparent if you look for it. It’s just that we’ve all more-or-less agreed not to look. Indeed, covert rationing is not a conspiracy being foisted on millions of innocent Americans by a vast and evil cabal. Much of the rationing activity is only poorly hidden, and its covert nature must rely on an almost willful failure of the “innocents” to recognize it for what it is. Furthermore, the individuals who are actually conducting the rationing - the doctors, the hospital administrators, the managed care and insurance executives, the scientists, the policymakers and regulators - for the most part subscribe to the same “no limits” mentality as everyone else. Most would probably find the notion of rationing healthcare to be repugnant, and would probably take offense if they should hear they are being accused of it.

The covert rationing of healthcare is, in fact, a textbook case of subconscious collusion.

Subconscious collusion is a defensive mechanism invoked by any social order when that social order is faced with an unpleasant fact of life that is a) unavoidable, and b) unacceptable. It is an unspoken, often subliminal decision to coexist with the unacceptable fact of life, but not to notice it, acknowledge it, or confront it. Consider the wife who subliminally decides not to notice that her husband is having a string of extramarital affairs. And consider the German populace during World War II, apparently failing to notice the holocaust. Subconscious collusion is a relatively common survival technique that allows a social order to persist, for a time, when some fundamental tenet of that order has become severely compromised. The major problem with subconscious collusion is that it allows the root problem to grow unchecked - and by definition, unnoticed - until the social order being “protected” implodes.

In the case of healthcare rationing, subconscious collusion operates thusly: First, the irresistible economic forces that require rationing and the irresistible social forces that forbid rationing line up to foster a certain attitude, a certain way of looking at things. Then, within every entity operating within the healthcare system, those who embrace such an attitude become ascendant, not by conspiracy or plot, but by natural market forces.

That certain correct attitude, the new “right stuff,” is defined by the ability to suggest actions that have the effect of limiting healthcare services, while couching those suggestions in the language of the culture of no limits. In essence, this kind of thinking allows organizations to direct the rationing of healthcare, while at the same time advancing the notion that rationing is unnecessary.

It is important to understand that there is surprisingly little hypocrisy under this scenario. While undoubtedly some of the individuals who are directing the rationing behavior understand exactly what they are doing, most genuinely continue to subscribe to the myth of “no limits.” Most honestly believe (or at least, want very badly to believe) that their actions are not reducing useful services, that instead, they are reducing waste and improving the efficiency of the system. Those who do understand the true nature of their actions generally shield themselves from having to communicate that knowledge. They are more likely to become the quiet, private CEO’s or Board Directors whose spokespersons and PR specialists (individuals who are entirely sincere about what they are telling the public) do their speaking for them.

So there is no conspiracy. The covert rationing of healthcare is conducted by a myriad of organizations, all acting quite independently, and all simply responding to economic and social imperatives. The key for organizations that want to flourish within our healthcare system, then, is to identify leaders who can respond both to the irresistible need to ration healthcare, and to the equally irresistible need to rationalize such behavior in terms acceptable to the rest of us. Those individuals, men and women of vision, are the Most Valuable Players in American healthcare.

The enabling visions advanced by such individuals - visions that permit covert rationing activities to go forward openly, freely, and often profitably - can be categorized into two general schools of thought. To really understand the mechanisms under which covert rationing operates in the United States, we need to have some familiarity with these two schools of thought. DrRich will introduce them in the next post.

Comments

Leave a Reply