What the Higgs boson and health care reform have in common
This comment first appeared on the Health, Not Medicine HoltzReport blog.
Along an undulating ridge just south of Menlo Park, Calif., SLAC runs laser-straight. It is my path not taken.
When I arrived for a tour during freshman orientation, SLAC stood for Stanford Linear Accelerator Center. The name has changed to the SLAC National Accelerator Laboratory, but the function is the same. It’s a drag strip that causes crashes. But rather than hosting funny car dragsters screeching to a few hundred mph, SLAC shoots particles with funny names to nearly the speed of light, just to see what happens when they hit head on.
SLAC is a direct ancestor of the Large Hadron Collider that produced subatomic fireworks that in turn produced fireworks in the physics, cosmology, and philosophy worlds with word that the Higgs boson almost certainly exists.
As I toured SLAC, I saw my Stanford studies possibly leading to a life-long pursuit of meaning in the squiggles of particle collision representations like those displayed with Higgs announcements. But my path veered off from the two-mile-long subterranean particle gun to another basement home: the newsroom of KZSU 90.1 FM. Halfway to a BS in physics, I pivoted from science to science journalism and ultimately to the health beat.
But that personal thread is not the Higgs-health care link to which the title of this note refers.
Do you understand what a Higgs boson really is? How it relates to photons, electrons, neutrinos, quarks, gluons, gravitons and other denizens of the quantum world? That’s okay. I can’t say I’ve got a solid grip on it all… and I studied this stuff (or at least what was taught about it decades ago) in a department liberally sprinkled with Nobel winners.
So what’s it got to do with health care reform? Well, it took me a lot of hard hours in classes like “The Philosophical Problems of Quantum Mechanics” to make peace with the chasm separating normal human experience from the quirky ways of quarks and their kin. Similarly, I’ve come to terms with health care only by surrendering any expectation that it works like normal business.
That’s not to say the quantum world or health care are without order and rules; it’s just that they aren’t the rules of the world most of us see and touch. We live in a Newtonian world. When I’d push through a swinging door on my way to introductory physics class, diagrams of vectors and angular momentum would pop into my head. I could feel the physics in my hand on the door. But in the quantum world, a photon is both a wave and a particle. Electrons don’t orbit an atomic nucleus the way planets loop around a star, they exist in probabilistic clouds, sort of everywhere and nowhere at the same time. Schrödinger's cat is simultaneously alive and dead.
It seems crazy, but do the right experiments and you get the same results every time. The formulas, the rules, work. They predict what will happen… even if the consistent result feels so wrong, so unnatural, so at odds with normal experience.
Likewise with health care. In normal life, demand drives supply; increasingly supply usually brings down prices. In health care, supply creates demand; prices may bear only a tenuous relationship to either the supply/demand balance or the cost of production. Double the number of MRIs in a city and the number of scans usually rises to try to satisfy the increased capacity. Meanwhile, under conventional fee-for-service payment, prices may actually rise if the machines (with largely fixed overhead) aren’t used as efficiently. Oh, and as far as health goes, the increased number of MRIs (and the increased spending on scans) will probably produce little or no additional health benefit, because when it’s easy to schedule a scan, people with less urgent need tend to get scanned, even if they’d probably be just fine without one.
You hear people say we should buy health care like we shop for other consumer items. Sure, if you are in the habit of buying a TV without knowing how much it will cost or whether it will tune in the stations you want to watch until after you bring it home and hire a crew to install it. No returns. And remember, you don’t really decide what to purchase, your doctor does. Next time you go shopping for a car, just give the salesperson a blank check and tell her to recommend whatever car she thinks you need.
But again, as with the quantum world, health care is not chaos, even if the order is difficult to discern. Most of us can’t make sense of things… but that doesn’t mean there are no rules. It does mean that expecting health care to work like home electronics is like expecting Higgs bosons to behave like billiard balls. Ain’t gonna happen.
There is one important way this analogy doesn’t work. Making health decisions and enacting health care policies based on a simplistic belief that health care works like normal things is likely to cost lives… and much of our economic future. In contrast, believing that the quantum world should behave like the world we see and feel is not likely to kill you… unless you are Schrödinger's cat.