I read a fascinating article recently, in which I learned that we each have a microbiome—essentially a cloud of germs, bacteria, and other critters—that live all over and inside of us. The total number of individual foreign bodies that make up this microbiome is TEN TIMES as many as the number of cells that make up our own body. And if you could gather them all up and set them on a scale, the collection would weigh about three pounds. Gross!
Typically the articles I’m reaching for don’t involve such microscopic work—rather, they tend to be looking at the big picture of health care systems change. They mostly focus on the institutions, the policies, the workforce, the patient populations, and the insurance industry, for example. But, suckered in by the possibility of learning more repellent facts about the human body (I wasn’t disappointed), I read on.
As intriguing as the healing powers of earwax are, the larger lesson I took from the article was that we need to change our perspective on achieving health from one of elimination and suppression of disease and illness to one of balancing our personal health ecosystems. We know that in the natural world, as much as we may dislike mosquitoes (the welts, the incessant buzzing, and of course, the malaria), killing them off as a species would radically change the planet’s overall balance.
Taking this lesson to a more macro level, we can see the need to think of health systems change in the same way. Does the movement toward getting all patients assigned to a primary care provider inadvertently sever some strong relationships with specialty care providers? Would eliminating the fee-for-service payment model disrupt some effective uses of it? If we succeed in getting health coverage for everyone, how will that affect access to care? In order to heal our health care system, it is important to ask ourselves these and other questions every step of the way so that we don’t disrupt the complex balance of quality, access, and cost.
Sometimes these questions aren’t obvious. Sometimes it doesn’t seem like there could possibly be a downside. Or, sometimes we quickly dismiss ideas that seem immediately offensive. But just as with our microbiome, what appears bad at first glance may be critical for balance upon closer inspection. The best solution is rarely the first one proposed or the easiest one to complete, but when it moves us closer to a balanced health care ecosystem, it will be worth the extra effort. To ensure the right balance we must do our due diligence—invite a variety of voices and perspectives to the table to discuss solutions, consider all possible outcomes, compromise, and move forward together.