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Monday, January 11, 2010

Triangulation may work for politics but not for love or health care

There is something fundamental about human interactions which is facilitated by the simplicity of just two parties. Let us look at love. There is no concept more complicated or unworkable as a love triangle. Granted there may be societies where polygamy rules, but I suspect this is because it is not about love. Throw love into the equation and a triangle becomes simply hopeless. Love involving two parties is complex. Love involving three parties becomes geometrically more complex and is essentially unworkable. People are almost always hurt.

In the beginning we had the physician and the patient, elegant in the simplicity of our relationship. Doctors, until recently could not do much and commanded modest sums for their services. Still we were attentive to our patients and we were respected by them in general. In the mid 20th century, the medical revolution took hold. We commanded even more respect from our patient although we were a less cheap date. To offset some costs we allowed a third party to enter into some of our transactions, the insurer. No big deal, our relationship with our patients was not affected substantially.

Roll forward to the new millennium. From it's modest roots, the relationship of doctors and patients is now thoroughly permeated with elements of the triangles; doctor, patient, insurer; doctor, patient healthcare system; doctor, insurer, healthcare system; patient, healthcare system, insurer; doctor, government, patient; insurer, healthcare system, government. Who loves whom? Who is beholden to whom? Whose money is it?

There is no question, love triangles can get very ugly. They involve control, money, love, respect, and autonomy. Triangles involving health care involve control, money, love, respect, autonomy and often health. We are fooling ourselves if we believe the long and clumsy arm of the state can domesticate these types of triangles. Reform as now offered serves us a more complex solution for a present system marked by unworkable complexity creating more vested parties and the replacement of love triangles with quadrangles, pentagons, and heptagons.


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