Like lemmings rushing to the sea they go. It seems the appropriate thing to do. After all, lemming leaders say they should do it. And once they start moving full speed ahead in this new direction, it never occurs to them to ask questions such as: Where are we headed? Why are we going? Do we need to go this fast? Is this really where we want to go? What will it be like when we finally arrive?
Some never make it to the water. They are run over or crushed in the process. Others have invested so much of their money making sure they are in the race that they drown when they finally reach the sea.
And so goes healthcare. Oh, we've had this race before. Sure, it was different then and we called it something else, but it must have worked. There are fewer lemmings now than there were then, and we all know that it is the strong that always survive. This race is market competition at its best.
After all, didn't the consultants tell us to create our own future and isn't that what we are doing? Who said anything about making sure it's a future we really want, a future that best serves the needs of our community?
We just want to get into the water first. We want to be the leaders. We want to be cutting edge. We've set our course. Don't bother us with questions along the way. This trip is market-driven. Employers and the federal government have said we must change, and change we will.
No matter that we don't like it either. No matter that business and industry aren't really developing this model with us. All they ask is that we contain costs. We must organize, integrate, regionalize and affiliate. We're in a hurry. If we don't do it, someone else will.
What do you mean we learned in the mid-'80s that healthcare is a market-specific product? What do you mean that an employer in Sacramento doesn't really care what we're doing in San Diego, let alone one in Seattle about what's happening in Kansas City? We want networks-big networks. We want networks that are statewide. We want nationwide networks. Why, we may even build a worldwide network.
What do you mean community responsibility? We're going to move patients out of their communities for services into these wonderful networks we've developed. They'll be happy to go to our regionalized centers. These centers are for them. They'll understand. It's for their good. We developed them to cut costs and raise quality.
Employers and other payers of care are going to stand in line to get their people into our networks. The name of this game is bodies. How many bodies do you have? You will need 100,000 bodies, 200,000 bodies, maybe even 1 million bodies to play this game. Why, if you don't have 100,000 bodies we might not even let you play.
What do you mean you're worried about the health of your community? We never cared about health. We said we did, but we were just kidding. There was no money in health. Insurance wouldn't pay for it, so we ignored it. We treat disease. That's where the money's been.
You say that health is not just the absence of disease. How could you say that? Look at all the wonderful things we've done for disease. Why, we can X-ray the tumor five different ways, and many times we do.
So who are you anyway? What do you do? And why are you so interested? You say you're a business owner with 400 employees. And how about you? What do you do? I see. You represent the Chamber of Commerce for this half of the United States.
I'll bet you're happy with us. We're doing exactly what you asked for. We're building networks for your people. We're going to save you lots of money. We've combined our empty-bed expertise with empty-bed expertise of five other noncompeting hospitals, and we're going to dominate this geographic area.
What do you mean this isn't what you asked for? You asked for cost containment. You asked for quality. You asked for predictability. You told us to work together. We're working together. What more do you want?
You say that what you really want is for us to work together with other providers in our own community. Providers we're competing with? We can't work with them. They tried to upstage us in magnetic resonance imaging and women's services just last year.
We're picking partners just outside our service area, and they in turn are picking partners just outside theirs. Then we're going to tie this all together into one big cohesive network. Haven't you heard that it's the one who gets the most bodies fastest who will survive?
Look, we've drawn circles all over this map. We're picking partners that complement what we're doing. When we get done we'll knock our competition flat. They can't survive if we've got all the bodies.
What do you mean you want us to concentrate within the community for the good of the community and that networking or regionalization should take place as an outgrowth of local planning and not be driven the other way around? Are you suggesting that networking outside a defined geographic area will probably be secondary at best and only work if it actually enhances or better enables us to serve the needs of the local community itself?
This sounds like heresy to me. It's not what the lemming leaders or consultants are saying, that's for sure.
You think that what we're doing is self-serving and that we're still trying to protect our own interests, don't you? I bet you think this craze will ultimately run its course and that we'll eventually come back and focus on the community as the distinct, dynamic unit that it is.
Well, what about the statewide networks? What about the multiple alliances? What about our ability to contract for zillions of people? Will this also run its cycle? Back in the '80s we even developed our own insurance companies.
You guys are out in left field.
Oh look, here comes a group of runners. Hospital presidents and some physicians. Hey, there's even an insurance company executive. I wonder where they're going. I think I'll go join them. I know, you think they're headed to the sea.
Oh well, I'm tired of running anyway. Guess I'll stay here and take care of my community. It's big enough for me.