Achieving Flight: Discerning Between Correlation And Causality in American Healthcare

In the opening chapters of How Will You Measure Your Life, Clayton Christensen illustrates why hundreds of years of attempts to fly were unsuccessful and what changed that got the Wright Brothers off of the ground.

“Early researchers observed strong correlations between being able to fly and having feathers and wings. Stories of men attempting to fly by strapping on wings date back hundreds of years. They were replicating what they believed allowed birds to soar: wings and feathers.

“Possessing these attributes had a high correlation—a connection between two things—with the ability to fly, but when humans attempted to follow what they believed were “best practices” of the most successful fliers by strapping on wings, then jumping off cathedrals and flapping hard … they failed. The mistake was that although feathers and wings were correlated with flying, the would-be aviators did not understand the fundamental causal mechanism—what actually causes something to happen—that enabled certain creatures to fly.”

“The real breakthrough in human flight didn’t come from crafting better wings or using more feathers. It was brought about by Dutch-Swiss mathematician Daniel Bernoulli and his book Hydrodynamica, a study of fluid mechanics. In 1738, he outlined what was to become known as Bernoulli’s principle, a theory that, when applied to flight, explained the concept of lift. We had gone from correlation (wings and feathers) to causality (lift).”

Reading through the passage, I immediately connected this principle with the US’s attempts to implement a national healthcare system.

Now, currently, no policy makers are making moves on Medicare for All. The country is nine weeks into a pandemic. Some states are slowly and cautiously reopening, and it seems we’re going to be in The Dance for another six to eighteen months. Oh, and in case you’ve forgotten, we’re six months away from a presidential election. Medicare for All isn’t at the top of our list of problems.

But once the political and healthcare dust has settled, the debate (or online rage-fest) of a national healthcare system will startup again. I wouldn’t be surprised to see both sides using the pandemic to support their position.

After reading the above passage from Christensen, I wondered. Would mimicking what other countries have done be like strapping wings on American healthcare system? Or would it be like applying the principles of lift? Will doing what other countries have done solve our problems?

What exactly are the problems the US system faces?

For one, value (measured in quality over cost) is low. Costs are higher than anywhere else in the OECD countries. And for all that extra money, outcomes seem about the same or worse. Second, roughly 27.5 million Americans (about 8.5%) are uninsured, which distributes costs to the rest of the system. Third, the incentives between who payers, patients, and providersmeans that consumers and providers often make decisions free of the monetary consequences of their choices, decreasing the power of free market tactics to cutting costs or improving quality.

In addition to our system’s issues, the US is unlike other OECD countries in its geographic and medical makeup. At 327.2 million citizens, we’re fifty times larger than the UK (6.5 million), and sixty times larger than Norway (5.5 million). About sixty million Americans (19.3%) live in rural areas where expensive healthcare services are harder to efficiently distribute. Add to the population issues a host of medical problems the country struggles with. For example, we’re close to the top of the list of most obese countries, with 36.2% of the population at a Body Mass Index of 30 or higher. Compare that to Canada (29.2%), Mexico (28.9%), and the UK (27.8%).

The unique problems and characteristics of the United States are significant. The ideal US healthcare system will need to be different from those of other countries that don’t share similar challenges. In other words, policy makers will need to craft incentives and systems to suit our unique situation in order to achieve flight, and not just mimick the surface characteristic of the healthcare systems of the OECD countries.