Getting ornery on social media: What I’m doing in 2019, episode 2

Sunday night I blogged this:

I haven’t been blogging nearly as much as I did five years ago, largely because my early blogging was all about trying to figure out “what the heck is up with the American healthcare system???” … it’s been two years since I had any new realizations.

Why would “figuring it out” make me stop blogging? Because as a change activist who’s also a public speaker, I’m gripped by one question: “What could be said that would make any difference?” There literally is no point in saying anything else. So once I realized how locked-in the system is, how intractable it is to change, I lost interest in flapping my gums and fingers.

But new things are in the wind, and it’s time to start pushing out those top learnings as foundation for what’s next. So, game on – in responses to two tweets, I got ornery:

1. “What would it take to support single payer?”

@ScriptHacker (John Irvine, former editor of the powerful TheHealthCareBlog) asked what it would take for patients to support a single-payer system (vs the US system of many competing insurers, with sneaky private pricing deals among many of them): lower taxes? Better wait times? etc. I responded with snark based on evidence:

I would require clear evidence that every health system in the world with better outcomes AND lower costs than us DOES have single payer. Oh wait, they all do. http://Dave.pt/malignantHC

That link goes to the “malignant tumor” post I blogged about last night, which established both the better outcomes and lower costs of every other developed nation. No matter what politics you prefer about who pays for what, there’s no denying those numbers.

There’s always lots to argue about in health policy, but it doesn’t make a damn bit of difference in getting the job done: you can have good or bad waiting times while your ship is sinking, and what I want (most people want) is better outcomes and lower costs. No other system is like the US, and they’re all better on both those points. Deal with it.:-)

2. Rebuttal to a nostalgic 2014 post

Twitter friend @UriGoren suggested that this 2014 post on KevinMD.com “There was a time when doctors were doctors” could use a patient rebuttal. It’s not a bad post – have a look. My “rebuttal” was not about defending patients – it was about how warped the post was, how half-blind:

I won’t bother w a rebuttal. It would make zero difference to people who were nostalgic back in 2014 for the time when real docs averaged 17 yrs behind the literature & hospitals killed 400k/year by accident.

It's okay 2b nostalgic for a FEELING, but own the messy truth, too.

— Dave deBronkart (@ePatientDave) April 28, 2019

I was citing the famous “17 years thing” that people everywhere love to quote (usually without knowing where it came from!!!), and the 2013 figure of 400,000 “premature deaths,” as the article put it, caused by medical mistakes. It would have done no good to complain about docs who are genuinely nostalgic – heck, I’m nostalgic for the days when I was good at typesetting and when I was good at writing software in QuickBasic. But y’know what? If you live long enough, things change! Deal with it.:-)

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In short, I’ve lost interest in endless debates about things that are true but don’t make any difference. When and if the system collapses or transforms there will be plenty of messes to clean up and things to do better when we start over, but for now, I’ll call a spade a spade, and start talking about what ordinary people can do to take care of themselves.

Do I sound ornery? Game on.

Did you know that “ornery” is a rural dialect pronunciation of “ordinary”? I learned that in my chorus – we’re learning an Appalachian carol that mentions “poor or’nery people like you and like I.”

It’s the “ornery” people who suffer when the system doesn’t achieve its potential. I stand with them.

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