Next Things First


Remembering Rick Carlson – In His Own Words by Rob Coppedge
April 23, 2009, 11:30 pm
Filed under: health policy | Tags: ,

Today in Seattle, the memory of health care thought leader and industry veteran Rick Carlson was celebrated by a room full of friends, family and colleagues. Around the room, Rick’s family had posted quotes from his articles and books – which served as both a testament to Rick’s talent as a thinker and writer and as a virtual history of health care reform efforts.

I appreciate Rick’s son Josh allowing us to share these excerpts. They are important now as we remember Rick – and perhaps even more so as we prepare for a yet another vigorous  health care debate.

“Well over half of those who seek physicians’ services do not have medical disorders. Rather they are afflicted by disorders of the spirit bred by the suffering and anguish that accompany life.….. [M]edicine has fostered a profoundly dependent public which searches for cures that do not exist.” The End of Medicine. Pg 26-27.

”Should all (technological) improvements be considered health care and thus covered by existing (insurance) plans – full speed ahead and damn the premiums?” The Terrible Gift. Pg 235. 2003.

“If someday we want to think seriously about subjugating medicine to the needs of society, there are basically three roads we can take. First, we can decide not to… Alternatively, we can ask government to level the playing field a la Scandinavia. … There is a third possible road: we can — and most likely we will — jury-rig a hybrid combining some of the pros and cons of each of the first two models.” The Terrible Gift. Pgs 231-233. 2003.

“The emergence of molecular control technologies raises a truly Darwinian question of survival for much of the human race. Perhaps Americans can plan safe and worthy use of biotech medicine only after we confront our true place in the world and learn to see ourselves as others see us. Until then, trusting our secret agencies with the keys to life could be the worst policy decision since Montezuma showed Cortez the Gold Room.” The Terrible Gift. Pg 223. 2003.

“Genomics will force us to decide what we are willing to pay for health care, in costs both financial and social. Because of its size and power, our health care system might be compared to a mighty river. As therapeutic medicine expands and an entirely new currents of upgrade medicine improve human endowments and performance, that stream could overflow its banks and inundate all other aspects of life.” The Terrible Gift. Pg xii. 2003.

“To a degree, the rise of personal genomics markets, generally, is an outgrowth of rising consumer activism in health care under the rubric of ‘consumer-directed health care.’ The policy objective is to increase the consumer’s investment of time, commitment to health living, and most of all money, into the health care system…. The long term expectation (hope?) is that an educated, motivated consumer with ‘skin-in-the-game’ will be more parsimonious in the use of scarce health care resources.” Personal Genomics: public policy at the frontier of consumer markets in health care. Pg 1. 2009.

“The personal genomics market leaders deny that they are just selling ‘curiosity’ to the affluent and worried well, arguing that individuals fortified with personalized data will be motivated to address and minimize controllable risk factors and hence prevent or at least slow the onset or progression of chronic disease. This is a provocative and promising premise, and may be right, but to date we have very little evidence to support it, acknowledging at the same time that we haven’t had enough experience with highly personalized risk information to know the likely answer.” Personal Genomics: public policy at the frontier of consumer markets in health care. Pg 2. 2009.

“..genetic discrimination can be practiced by communities, and social systems, not just by employers and insurance companies, though its forms are different….And, finally, it is now being appreciated that much of our accumulating genetic information could lead us down one of the slipperiest of slopes if it becomes the fodder for engineering human perfection.” Personal Genomics: public policy at the frontier of consumer markets in health care. Pg 5. 2009.

“In my view, the choice to develop a system to delivery medical care through nearly exclusive allocation of resources for that purpose, was made for political, social and economic reasons rather than for therapeutic ones.” Western Journal of Medicine. Pg 466. 1979.

“Holistic thinking, as an epistemological notion, requires that human beings be perceived as whole persons made up of physiological, emotional, intellectual and spiritual dimensions that dynamically interact, and that any approach to improving the health of human beings, either individually or in groups, requires placing them in a larger and richer context than does traditional medicine.” Western Journal of Medicine. Pg 468. 1979.

“In health care, genomics technologies are disruptive yet potentially cost-effective because they enable primary prevention, the antidote to runaway costs and declining productivity. The challenges to integration are great, however, and many bioethical and social-policy implications are alarming. …we must debate genomics vigorously if we are to act wisely. Public policy must lead.” Journal of Health Politics, Policy and Law. Pg 39. 2008.

“ [genomics] is aikido, not Special Forces. Genomics taps the body’s wisdom by immersing itself in the ebb and flow of the body’s information system – the genome – rather than by looking only to extirpate the results of molecules gone bad by providing a patch and then leaving us ignorant of the proximate cause…. We are not born healthy and made sick; rather we are born predisposed to certain conditions, characteristics, strengths, and limitations.” Journal of Health Politics, Policy and Law. Pg 42. 2008.

“As genomics metastasizes, every business model for every health care sector will be affected, some profoundly.” Journal of Health Politics, Policy and Law. Pg 43. 2008.

“[HMOs’] initial cost-cutting success – achieved with an axe, not a scalpel – led the way to the hedgerows of the vilified managed care cost-control systems that followed.” Journal of Health Politics, Policy and Law. Pg 46. 2008.

“Lots of money will always be made in health care – we just need to give those who make markets reasons to make the ones that would improve our public’s health.” Journal of Health Politics, Policy and Law. Pg 48. 2008.

“In the 1950’s, when the Salk vaccine displaced the crude technology of the Iron Lung, science writers and the popular press loudly proclaimed the arrival of a golden age of modern medicine, a medicine that would systematically eradicate the lengthy and gory list of human maladies. That age proved to be more tin than gold. ..This must necessarily chasten any prediction about the future of medicine.” Public Health Genomics. Pg 180. 2009.

“Our private health insurance model is a hybrid of economic ruthlessness and utilitarian social policy…. through which we are made to take care of each other though abstractly, because the benefits we don’t need go to meet the needs of others we don’t know.” Public Health Genomics. Pg 182. 2009.

“There is a real peril that lowbrow theories wrapped in tendentious and oily slogans will get the public’s ear and gain even footing with scientific proof as worthy of belief.” Health Affairs. Pg W-5-467. 2005.

“Real reform is not on the agenda. There is no money for real reform because we spend it all on medicine.” Healthcare Forum Journal. Pg 18. 1993.

“Policy initiatives are being tossed around like obscenities at a hockey game…” Healthcare Forum Journal. Pg 18. 1993.

“Perversely, since job creation is the central goal of this new administration, reforming the medical care system by cutting costs may just be the worst thing to do…. No tooling up is required. Just let the tides loose. Medical care can and will encroach like the worst weeds in your prized front lawn.” Healthcare Forum Journal. Pg 21. 1993.

“Here are my suggestions for initiating real reform:

  1. Explode the physicians’ worm’s-eye view

  2. Dismantle the replicating engine

  3. Discipline the spoiled child

  4. Turn the reward system upside down

  5. Honor the consumer

  6. Admit that we can’t afford it anymore

  7. Get rid of the insurance industry

  8. Force medicine to be a science

  9. Advocate health aging”

Healthcare Forum Journal. Pgs. 18-26. 1993.

Posted by RobC

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