Collaboration versus Competition: Letting the Natural Order Work

Abstract

Collaboration versus competition--Russ Coile makes a very eloquent and comprehensive case for the advantages of a collaborative approach over a competitive one to solving the shortcomings of the U.S. health care delivery Unfortunately, collaboration will not and has not worked. A competitive approach is not ideal because it yields winners and losers. In terms of health care services delivery, there should not be any winners and losers. Why won't collaboration work! In the simplest terms, it is against basic human nature. To solve our health care problems, we need to channel competition in a positive rather than a negative fashion. THE COLLABORATIVE APPROACH Russ Coile's basic premise is of a national health system built on collaborative efforts between purchasers and providers and consumers and government that makes universal access to health care available and contains costs through voluntary collective action at the national, state, and local levels. However, people act in their own self-interests. This is a basic law of human nature. For Coile's collaborative effort to succeed, a group of people must be able to put the collective interests above their own. For years, the fallacy of the commons has intrigued us all. Why, when it is so obvious that everyone has to work together, people seem to want to take their own piece of the action, regardless of the impact on the group at large? It is because people work toward their own self-interests. As biological creatures, we live a competitive existence, fighting for food, air, space, and well-being. The law of the jungle is the survival of the fittest. We are by our nature competitive beings, and as such, we apply a competitive model to our social activities as well as our biological activities. The U.S. health care system has been built on fee-for-service medicine. Do a procedure, perform a test, provide a day of care, and receive payment. A provider's self-interest is served by generating income through a service. Our system has expanded substantially over the past 30 years as there has been and money made available through government and private funding sources to pay for health care. Insurance companies, doctors, hospitals, and medical entrepreneurs have seen their monetary interests served well by this do more, make more delivery In Coile's scheme, these groups that have done so well are expected to shift their orientation, to put the interests of society before their own. I wish that could happen, but people not change unless the pain is great. The fear of price controls and stringent regulatory approaches is not strong enough to bring about change. Coile makes the statement that managing the cooperative implementation of health reform is the last, best hope of a voluntary American system. He goes on to say that health is social service than market commodity. Unfortunately, once the government stepped into the system, health went from a social good to a market commodity. He states that the solution for the excesses of competition is to engage in a multiparty cooperative structural reform by all major stockholders--the public, elected officials, insurers and managed care plans, hospitals, physicians and other health professionals, major and small employers, and government. Each of these stockholders- has its own self-interests, needs, and wants. It is impossible for all of them to agree on a common agenda, much less work together in the spirit of a common social good. We are competitive beings, and we will pursue competitive instincts and seek to eliminate all impediments to achieving individual success. MANAGED COMPETITION A sound approach is to harness the competitive power of economic self-interest, change the payment system, and put in place a safety net for those less fortunate. The managed competition approach outlined by the Jackson Hole Group over the past two years and the much earlier Consumer Choice Health Plan concept outlined by Alain Enthoven seek to put providers in a market-driven environment where the consumer of the service is like the customer. …