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Sunday, January 21, 2018

System issues v. personal blame

I listen to the banter out of Washington, bickering about "blame" for current events. What it brings to mind are recent discussions within healthcare about blame. Much is dysfunctional about health care but one thing we are moving past is the concept of blame. Historically, when bad outcomes happened the reflex was to look for someone to blame, but the safety and quality movement have begun to change our perspective. We ahve come to realize that while specific individuals may play roles in specific bad outcomes in healthcare, often system issues dwarf the responsibilities of specific people.

I will not argue that specific people are acting in ways which aggravate current dysfunctions in Washington, not the least of which is our current A...hole in chief. However, he is not alone in being immature (although he takes it to new lows). I would argue that he is a problem but he is not THE major problem. Budget dysfunction predated him. 

I was thinking about this issue for the past few days and low and behold Peter Suderman wrote a spot on piece in the NYT today regarding just this (Suderman NYT). We are now experiencing the consequence of poorly conceived legislative process (40 years old) coupled with shrinking discretionary dollars which has created an increasingly partisan environment driving a culture of brinkmanship.

Blame games will get us nowhere except for a spiral downward.  We need to grasp and embrace an understanding that  no single person or party can be blamed for our current state. Congress, past and present is to blame. The Presidents, past and present are to blame. The American people, past and present are to blame. We elected everyone in Washington and embraced expectations of Washington that are unattainable.

We can change who represents us but that will not get us much meaningful change unless we fix system issues which are the primary drivers of dysfunction. 

3 comments:

Unknown said...

Systematic change? Of course. But what? Other developed countries have worked out their own versions of something like Medicare for all. How are they different than the US? I would posit 2 major factors. They 1) don't have a bloated military/state security/empire maintanence complex and 2) don't have a for-profit insurance bureaucracy.
Our whole system is rife with tapeworms that are very happy with they way things are and are not about to let go.

The Medical Contrarian said...

They all suffer from similar issues where growth of entitlements outstrips growth of the economy. They do not have as much of a military burden. We provided a buffer to their economies for the post WWII period. However, like us, unless they are able to make structural changes, their day of reckoning is coming. They have made promises to future generations which they will not be able to honor unless they can figure out how to deal with the demographic and economic growth problems they are facing.

Unknown said...

We can start by having our expenditures pay dividends to those future generations. More investment in Infrastructure, education, research, better management of the environment. Hell, print money for that stuff. It’ll pay for itself over time and employ tax paying self sufficient people in the present.

It would be terrific if our national policies were about creating the most vibrant capitalist economy possible. It is not. And that’s by design. The whole debate of left vs. right is a diversionary sham, a side show circus to the real power plays going on.

What ever happened to the ”peace dividend”?