How much waste is built into our health care system?

In the past week, I took three different domestic flights, on three different airlines.

This, in of itself, is not a big deal. Each of the trips were to known destinations, and I did not need any more than my standard carry on. Easy trips, TSA-pre airports, on, off, on to the next.

Except that the week before, I broke my arm. Also not a big deal, not a bad break. Only that now, I could not lift my carry-on bags, onto the plane, or the belt at the security scan.

Feeling a bit fragile and unraveled with my encumbered arm, I called each of the three airlines, to request assistance going through security and getting my bags on the plane. And each of the three airlines insisted that the only kind of assistance they could offer was wheelchair service.

When I arrived at the airport, I again tried to explain to the airline representatives that I did not need a wheelchair, I could walk perfectly fine, I only needed help lifting my heavy bags.  And each time, I was given a zero-sum option. Either I wanted the help of the attendant, which came with a wheelchair, or I could go on my own.

I got in the chair.

Sitting obediently in the wheelchair, speeding past people who genuinely looked like they could use a helping hand (families with strollers and toddlers, people walking slowly with canes), I felt guilty, but also mystified, as this built-in gap in the service of airlines, and the wastefulness of taking up space (in a wheelchair) and the effort (of the wheelchair pusher), when all I needed was a few minutes help at the security checkpoint, and at the boarding gate. Wouldn’t others also be served more effectively if someone was available at security, and during the boarding process, just available on an ad-hoc basis? Like the now-elusive salespeople who used to inhabit department stores to show you the way to the fitting room? Or like those greeters at certain Asian or Canadian airports who cheerfully, helpfully, show you where you need to go?

This pattern was remembered to me at my intermediate destination, during a conversation with a dear relative, a very sharp, elegant Manhattanite, who is now in her 80s.

She related to me what happened during a recent hospital visit. She went to the emergency room on a Saturday, with known, recurrent symptoms. The doctors were fairly confident of her diagnosis, (resulting from an ongoing condition) but wanted further testing to be sure. Since no-one at the hospital was available to perform these tests on Saturday or Sunday, she was given a choice.

“We can keep you until Monday, and you can have the tests then. Or, we can discharge you, and you can go home. But then you’ll have the status of outpatient, and as an outpatient, you’ll have to wait two weeks for an appointment.”

Again, a binary choice, zero-sum. No in between.

Like me, my relative chose the extra caution and convenience of the earlier appointment. She was admitted to the hospital until she was able to be tested on Monday, and then went home with her treatment plans.

Later, she received a bill for $16,000 for her 3-day hospital stay, which was cheerfully sent on to Medicare to pay.

It got me thinking. How much waste is built into our health care system? Is it really less expensive for a hospital to only employ those professionals who are responsible for testing Monday through Friday, when it leads to unnecessary admissions and inpatient stays, played out, potentially, in numerous hospitals, numerous times throughout a given year?

Every link in the healthcare system (as in the airline industry) is being bludgeoned over the head with these mantra-mandates: Cut Costs. Create Value. Save Money.

But are we really looking at our organizations, and the way things have always been done, with an eye to reducing redundancies, increasing efficiencies, and helping people when and where they actually do need vital services?

I think this question extends into the psychological realm as well. When we approach our challenges with a rigid, binary, either-or mindset, we may be missing the point. How can we be open to more nuanced, gentler solutions, that can meet our needs in a more holistic and efficient way?

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