Hobbes, Hume … and Healthcare

A recent 60 Minutes episode on the Stoneman Douglas leaders of the #neveragain movement included a discussion with Emma Gonzales’ mother. We stand behind her, Emma’s mother’s friends said. “You go out and get that law changed. But where are we – we should have done this 20 years ago.” – was the elder Gonzales’ response.

In the six weeks since the Parkland shooting, the kids of the #neveragain movement have successfully waged war on the ridiculous gun promiscuity in the this county. They’ve helped spearhead a nationwide student walkout that took place in over 3000 schools. On March 24th, a week ago, they organized the March For Our Lives in Washington D.C. and over 800 other cities worldwide. Crowd estimates in D.C. alone were over 700,000. Limited gun control legislature has been passed in several states as well as nationally. These kids of the “no fear” generation have become the adults in the room – while the adults are at the kids table throwing peas at each other.

The older generations in power are standing behind the kids. But that’s as far as it goes. As adults we sit by paralyzed – hoping the kids will fix the problems we created. We’ve become fat and lazy. We complain about special interests in government yet we keep electing the same clowns. We complain about the Russians manipulating our beloved Facebook news feeds getting us to believe some nonsense that any 12 old year with common sense wouldn’t fall for. The fat from our McDonalds quarter pounders has seeped into our brains and made us functionally illiterate barely able to conduct our daily lives without help. So instead we look for a crutch – “the man in the white hat … riding in on the white horse.”

The most basic of human instincts is fear. And fear was the main reason Trump was elected … and now it has become an integral part of our society. We’re so scared we don’t even try to think whether the perceived threat is real. The prospect of the bogeyman under the bed dictates our daily decision-making. Trump and his GOP minions are portraying anyone and anything that isn’t white and god-fearing as being evil and out to take your job, your right to the American dream … and most importantly your guns.

America’s Cable News Democracy

“Nothing pains some people more than having to think.” – Dr. Martin Luther King Jr.

Politics is no longer something we participate in. It’s something we observe from our living room couch while watching whatever cable news channel we’ve become addicted to. We take sides with our television remote and go to battle on Facebook and Twitter slinging mud via anonymous usernames like @JesusLovesGuns. The actual work of civics and building of communities – we have no time for that. @JesusLovesGuns has too much work to do battling the hordes of teenage heathens out to impose their George Soros implanted communist mind control on us true patriots. God, guns and good old American whiteness … that’s what we’re here for. In the end though, we know the “big man” in the White House will do the real work for us … white hat and white horse right along with him.

After all, we’re American and we deserve it. We deserve it all. It’s our birthright. The government (even though we hate it) is here to ensure our American Dream – regardless what decisions we personally make. The idea we would band together and work ourselves to create something for the collective good – no that’s not how it works. We got the White House, the white hat and white horse.

Health and the Fallacy of Care

But our abdication of responsibilities doesn’t end with our misconstruct of civic duty. Maybe more impactful than America’s distorted opinion of democracy – is its view of health and the role we play in our own. We’ve elevated the profession of medicine to unhealthy levels. Most of us, no matter how intelligent we may be, seem to turn off our brains when in the presence of a doctor. And if it’s not bad enough that we stand there self-imposed intellectually naked – we’re rarely thrown a metaphorical robe … instead peppered with jargon and really, really big words designed only to intimidate us. Claustrophobic nondescript exam rooms, and accompanying clinical props create the psychological equivalent of an alligator-filled moat separating us from parity and any human aspects of the experience.

I don’t mean to be insinuating that physicians aren’t caring (most are) and empathetic (many are). Instead I want to bring to light the role of the ill-designed concept of Electronic Health Records. Fueling this physician/patient disconnect is the abomination otherwise know as EHR systems. These EHRs are billing software that have morphed into the central nervous system for the convergence between computer technology and healthcare. They are universally hated by practitioners, but the C-Suite continues to pile them on, oblivious to the detrimental effects they have on the health of the life blood of the their organizations – physicians. These EHR systems now dictate the parameters of the physician/patient relationship. It’s like physicians have given up and turned their careers and the healthcare industry over to the Boss Hoggs in the C-Suite. But the true losers are patients. Instead of ways to restore humanity to the healthcare process, all I hear are high-tech bells and whistles like AI, VR and blockchain. I’m as technical as anyone – but is the solution really to add more technology on top of a fundamentally flawed foundation to start with.

The technical solutions I see having have promise are related to patient engagement and collaboration, mainly communication-based behavior modification. But even here – imagination is lacking. Most firms seem to be focused on creating apps reminding us taking take our pills. It’s probably no surprise that the when discussing careers in healthcare, we say medicine. Instead of saying they were in medicine, imagine if a doctor said they were in the field well-being and self-efficacy enhancement. You’d tell them to take a pill.

I find it bizarre when it come to healthcare we feel the need for patient advocates. Do we have advocates for our experience at McDonalds or 7-Eleven? It’s not like we’re given our healthcare for free. On the contrary, the healthcare industry should have advocates to justify their unaccountable high prices. Unlike any other industry, we can’t describe ourselves as customers. It’s akin to blasphemy. Being a customer means we have a choice and that alters the balance of power. Whether intentional or not – the concept of patient subservience is baked into the healthcare model. In some cases it applies and needs to … but in most it’s purely a choice (or lack of) we make when we personally define what health and being healthy means to each of us.

I feel like we’re dogs walking around with leashes around our necks only there’s no one holding onto the other side. We just assume there is. In fact we just assume that’s someone holding onto the leash in most everything we do. In fact it’s so bad that we spend our days conforming to societal norms and expectations. We seldom think about where they came from or question whether they have relevance today. Conformity is what we strive for

Locus of Control, Hobbes and Hume

In 1966, renowned behavioral scientist Julian Rotter developed the concept of locus of control – a variable that describes individual differences between people. Based on this concept, people vary in terms of the degree to which they have an internal locus of control (meaning that they believe that outcomes in their world follow from their personal actions) versus those who have an external locus of control (meaning that they believe that outcomes in their world are generally unrelated to their personal actions). If you have an internal locus of control, you are confident that your actions will lead to change. But if you have external locus of control, you might not even bother trying, because you have learned across your life that little follows from your actions. (Psychology Today)

This tradition of giving way to the external locus of control is rooted in the philosophies of Englishman Thomas Hobbes and his theory of social order. From his perspective, individual actors pursuing their own interests and trying to maximize their welfare lead inevitably to chaos and conflict. From that is derived the necessity of a single center of power imposing order. In Hobbes’ view, social order is the creation of the unique “Leviathan,” which wields the monopoly power to make and enforce law. Self-organized and independent individuals thus have nothing to do with making order. Most modern theories of “The State” have their origins in Hobbes’ vision of Leviathan.

Thomas Hobbes and his theories of the Leviathan have forged the foundation of industrialization. While at the time it seemed only applicable to the reverence of the church and royalty, it morphed once Adam Smith arrived in the 1700s. Even though Smith’s philosophy is the gospel of capitalism – his real message was much deeper and humane. To Smith, every business transaction is a moral challenge to see that both parties come out fairly. Unfortunately much of that message has been lost in transition or just discarded over the years for not fitting into greedy overlords’ predetermined agendas.

I suppose America can take solace in the fact that we’re not the only ones who choose to be subservient to a greater human power. In so-called industrial nations, industrialization isn’t necessary synonymous with being cerebrally evolved. In fact there’s a case to be made that industrialization has hindered our ability to make decisions for ourselves. Years of working for “the man” where “the man” makes our decisions for us; giving us long-term employment, health insurance and the such has cauterised our synapses – making us unable to forge the new cerebral pathways needed to function in a self-determinant society.

On the opposite end of the philosophical spectrum are the social constructs of 18th Century Scottish philosopher David Hume. Hume theorized that people are inherently good. What if rather than religiously following the philosophy of Thomas Hobbes (proponent of all-encompassing government) and his pessimistic views of humanity … we looked instead to Hume. He believed we were born with the virtues of benevolence, trust and commitment. This ‘spontaneous order’ did not need to be enforced by a greater overarching power or institution of human or theological making., but rather would individually and collectively be more efficient and ordered on its own. Hume’s argument was that, in the absence of a system of centralized command, conventions emerge that minimize conflict and organize social activities (including production) in a manner that is most conducive to the Good Life.

The No Fear Generation and Future of Healthcare

Let us not lose hope though. Even as us adults continue to fight over the toys in the toybox – the real adults in the room, our nation’s youth, all full of internal locus of control and self-efficacy, might actually be “the man in white hat on the white horse” riding in to save us. They don’t fear the system. They don’t expect the system to fix anything while they sit idly by. And they are not acting individually. They are taking the social media tools they’ve grown up with and are using them collectively as weapons to battle the unjust, inequitable system they see as functionally and morally wrong. Many call it a David and Goliath story – and that it may be. But because of their organizational and technical savvy, unbridled energy and intolerance of bullshit – today’s youth may actually be the Goliath. The status quo is walking dead and it doesn’t even know it.

The questions us adults should be asking ourselves is – how we be like the young and harness their sense of self-efficacy? How can we break free of the shackles that bind us to the couch as we get fatter and lazier pounding out keystrokes, parroting what we see in front of us on cable news.

While we could focus on the sad state of politics and civic engagement in this country – all that’s contingent on the more pressing issue of how do get and keep ourselves well. How do we decide that keeping ourselves physically, mentally and socially healthy is our responsibility – not of a healthcare system that we can all agree on is an operational disaster. And when we do – what steps must we take to set us on a path of self-efficacy and internal locus of control.

This internal locust of control needs to start with us by defining who each of us are and who we want to be. Then can we create an action plan to connect the two. This action plan is a road map for what I call our “Journey To Our Perfect World.” The emphasis is on the journey rather than the destination. Below are the ground rules for our new plan of self-actualization.

  • Our locus of control is internal: What we do as individuals matters to our health and well-being. We are not tools of fate. We understand many parties play a role – but we are the ones who have the greatest stake in the outcome of our actions. As a result; we may want to incorporate new ideas, additional players and new technologies to help us elevate our self-efficacy and improve outcomes.
  • We want collaboration: Our goal is positive health and well-being – and from whomever we choose to join us on this journey, we expect to work together collaboratively (including physicians, stakeholders, other friends and family and even fellow community members).
  • We are customers: At times we may be patients, some of us more and longer than others – but in the end, we’re still customers. And with being a customer comes choice, a choice that is ours.
  • Our community is an integral part of the solution: Not only do our own actions dictate the level of our health – so do our interactions with those around us where we live. We are products of our communities and the level of health is dependent on the engagements we have. The healthier and stronger our communities are – healthier and stronger we will be individually.

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The Journey To Our Perfect World: The Map

  • Overview and Assessment:
    • Where do I want to go and when do I want to get there (personally and professionally)
    • Where have I been (personally and professionally)
    • Where I am now (personally and professionally)
  • Resources:
    • What do I need to go where I want to go (personally, from others)
    • What do I currently have
    • What do I need that I don’t current have and where can I get it

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How can we demand the healthcare model I described above – one where we’re at the center of the process? How can we demand that our doctors and healthcare providers view us as true collaborators? How do we break the nonsensical cycle of unnecessarily procedures, appointments and tests that produce little benefit and only further perpetuate the inefficiencies of the status quo? How can we break the norm of thinking that our health begins and ends at the clinic walls? And how can we get our healthcare providers to see the community as integral part of our health and in turn use their power and financial resources to make it better?

In the end, it will be up to us to organize like David Hogg, Emma Gonzales, Jaclyn Corin and Cameron Kasky. Even though their cause is gun control … we can learn from them and the other young empowered leaders of the #neveragain movement. The healthcare industry won’t change on its own. It will have to be forced to – screaming and yelling … and throwing up unimaginable obstacles along the way . But we have power in numbers … and our numbers can speak truth to power … if we only dare.

We just need to keep screaming … and may we have half the insight, passion and courage Jaclyn does.

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See Community 3.0 for your prescription for speaking truth to power by organizing your towns and cities around the Front Porches of your community by elevating the health and well-being of you, your neighbors and friends.

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