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Goodhart’s law – named after a former chief economist of the Bank of England – says that whatever social or economic indicator or other surrogate measure you adopt as a financial target ceases to be a relevant target once you have adopted it because it loses the information content it had originally.

What is the risk that, as soon as the health care system reform becomes an intense focus of policy (as it is now), more and more attention will get devoted, not to controlling health care spending, but to continuing to spend while finding reasons why what was just spent does not form part of what could/should be reformed? Based on the developments of last 2 weeks, including the huge fight over the real cost of the proposed reform and the continuing discussion over Atul Gawande’s masterful article, “The Cost Conundrum” , my guess is that we are heading straight into Goodhart’s kingdom. Seriously, when was the last time you saw a winner of the Nobel Memorial Prize in Economics make a comment in a blog post about health care?

Discussions about the reform of the system are clearly no longer directed to improve care, outcomes and  patient experience. On the contrary conversations have become almost exclusively about lowered costs. It is as though most of the people involved in thinking about the reform really don’t want to remember that medicine (the topic central to health care reform) is all about you and me, the current and future patients, not about saving an array of professionals whose income has become totally dependent on the accumulated and constantly growing dysfunctions of the system.

Health care reform should start with simply accepting that all human beings have the right to be treated as human beings, in sickness just as much as in health. As long as our bodies remain the best income proxies for millions of Americans whose business depends on extracting as much value from sickness as possible we will have a nasty case of Goodhart’s law and real reform will remain impossible.

Pay attention to how the politicos and the media are churning news, almost non-stop, about how much the reform will cost. Will it be $1 trillion, $1.6 trillion or $3.7 trillion? Ask the average person and they’ll almost certainly look at you with eyes filled with fear and guilt, because everybody knows something must be done but frankly, the more we hear about it the more we experience that it’s just too overwhelming.  We have been spoon fed sophisticated lies for too long. Because we have been used as the proxy source of income for all the participants of Opaque, Inc we have never been told:

  • what is the real cost of care for each one of us and,
  • how we have been brainwashed to believe that so called unlimited medical choices always result in better outcome.

Attacked by soundbites that include one of the huge numbers, we become paralyzed and unable to start questioning any of the statements made by each of the defenders of the established order, as well all the statements made by politicians who are almost always motivated by undeclared biases.

But when the dust settles, we will be left with one simple question. Are we getting better care than before? My theory is that you cannot reform the health care system as long as you fixate on the system. It is too broken and too dysfunctional for multiple reasons as noted by countless experts. But almost none of these experts live and breathe what the people in this blog are experiencing daily.

Health care is not about money, it is about care. It is not about RBRVS, it is about helping the patients having to make complex decisions about pros and cons of various treatment options. It is not about private insurance vs public plan, it should be about health and wellness. It is not about unnecessary procedures, it is about ending the paternalistic model of medicine. Truly empower the patients and they’ll be able to see through many of the dysfunctions and will force changes faster than any mandated reform.


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