It's Not an Emergency

After a brief hiatus, during which the team from Failure - the Podcast/Innovation Blab/5-Minute Update contemplated their umbilici (think, M.C. Escher), we found ourselves at the Yale University School of Medicine to continue our exploration of the health care system.  Our intent was to learn about urban health care from an emergency room perspective, and we had an outstanding guide: Dr. Arjun Venkatesh.  He is the Chair of the Department of Emergency Medicine at Yale and a practitioner, as well.

Mark and Jeff, avid fans of HBO Max’s “The Pitt,” quickly lost the journalist’s sense and overwhelmed the good doctor with questions: What is the most realistic TV medical drama? (Yes, The Pitt). Why is actor Noah Wyle an honorary MD?  (He isn’t, he just plays one on TV). Is The Pitt filmed before a studio audience? (Surprisingly, no). Did Grey’s Anatomy use real patients? (Are you kidding?)

Finally back on track, the team had a serious discussion with Dr. Venkatesh about health care delivery.  “We’re not failing like we did in the 1970s,” he said. “But we’re not getting what we pay for.” Still, he had a hopeful prognosis of the American healthcare system, albeit one requiring longer-term thinking, centralized coordination, and political will.

From Dr. Venkatesh’s perspective, the current system is overwhelmed by well-intentioned but disjointed efforts. At his own emergency department, for example, 47 separate quality improvement initiatives were active on a single day—each addressing a different problem, but few seeing completion.

One of Dr. Venkatesh’s most provocative proposals was a shift from annual insurance cycles to 10- or 30-year health plans. “Right now, insurers only care about your health for three to five years,” he said. “If they had to manage your care for a decade, they’d invest in prevention and long-term outcomes.” He also saw promise in Germany’s hybrid model: centralized financing with decentralized delivery.

Though Mark and Jeff remained a bit distracted — hoping to get Dr. Venkatesh to offer a second opinion on the diagnosis central to season #1, episode 7 of The Pitt — the good doctor returned to a central theme of our discussion: healthcare is a political decision. From Medicaid expansion to vaccine access, he argued that the system reflects the values and priorities of policymakers.  “We made a political choice last week to reduce Medicaid coverage,” he said. “That’s not a technical failure. That’s a choice.”

Join the team from Failure - the Podcast/Innovation Blab/5-Minute Update as we resuscitate ourselves with the kind assistance of a top ER doctor.  Listen to the full episode and you’ll be ready for this listener challenge:  is excreting “blue pee” ever a good thing?