Great thinking is built on great questions. Unfortunately, it seems to me, we have started with answers before we agreed on the important questions.
One of my favorite books is Asking the Right Questions: a Guide to Critical Thinking by Browne and Keeley. Let’s see how a few of their questions help inform the discussion about health care
- What are the issues and the conclusions?
- Let’s stick with the issues from the last post: coverage, quality, cost, and choice. We are still wrestling with the conclusions about each of these issues. Coverage seems to be the big Democratic issue and a conclusion for many is that coverage needs to be universal. Cost and choice seem to be the big issues for the Republicans and tentative conclusions are that cost will be too high and that choice is important and will be hurt by a “government” agency.
- Bring this down a notch and look at it from the perspective of a hospital executive: universal coverage is good; high quality is demanded; cost should “reasonable;” and choice may be bad if it adds to administrative costs.
- What words or phrases are not clear?
- Do we have common understanding of: “rationing,” “free market,” “recission,” “Obamacare,” “level playing field,” “socialism,” or, for that matter, “health.” Think back to the days of the “quality” movement – lots of discussion by what we meant by quality.
- What are the value conflicts and assumptions?
- Is the healthcare system run as a “zero sum” game. Does one party win at the expense of the other? Unfortunately all of the public “debate” has focused on differences and not common ground.
- What line items should be used in a healthcare system report card? Until we have a common set of items we can cherry pick “the best system” to fit our needs.
- There are a bunch of assumptions that have to be investigated: Will quality reduce cost (like it did for manufacturing)?
- How good is the evidence?
- There are bits and pieces of evidence floating around, but little has been used in coming to terms with the debate. Furthermore, when numbers are presented they are not always put in proper context nor made widely available.
- What evidence would you want to see to come to grips with the issues of coverage, quality, cost and choice?
- Are the statistics deceptive?
- The short answer is Yes. We have to make sure we understand the basis behind the numbers.
We have a lot of very smart people who can find answers once we have posed the right questions. From your point of view, what are important questions that no one seems to answer?