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Good, Fast, Cheap – pick any two

I was trained as an engineer, back in the day when reality was the touchstone for pretty much any project. Engineers are trained to be both practical and realistic. We can not change the laws of physics, we must adapt our designs to incorporate their (definite) existance, and their unfortunate nature of being utterly and completely consistent.

One of the very first things you learn in the cold cruel world is an axiom that has been proven true time and time again by people much smarter than you, the young engineer, are. It’s called many things (some of which would violate redstate’s terms of service), but my name for it is “The Iron Triangle” which usually is expressed: Good, Fast, or Cheap – pick any two.

Good, fast, cheap - the Iron TriangleIt’s so utterly simple that most people know it almost by instinct. It’s the practical application of external constraints on any project. Think about it in your normal life. If you want something fast and good, it’s not going to be cheap. If you want something good and cheap, you probably aren’t going to get it fast. And if you want something fast and cheap, it’s not going to be good.

I’m sure that you can find examples in your own lives that reflect the iron triangle. Check your vacations, your family budget, your car purchases. Or, check your health care.

In America, we have the best heath care treatments in the world. (Best=Good) and you don’t have to wait in interminable lines, we do things quickly (Fast). Guess what? It ain’t cheap.

Good, fast, or cheap - a practical application This sign says it all.

But we are promised good and cheap health care. Guess what invariably happens? You got it in one: SLOW. I’ll leave it to the reader to answer the question of where you can find this model today, eh?

When you try to make the system faster (because we CAN’T have people waiting a year for an operation, it’s INHUMAN!), you will lose either cheap or good. And unfortunately, since saving dollars (cheap) is the reason given for doing this in the first place… well…. you sacrifice quality (good) and people suffer more.

Then, the people, fed up with substandard and slow care, complain more. The morons running this train finally are slapped upside the head with the cold hard reality that the only way they can give good and fast is to raise costs (cheap) to unacceptable, and unsustainable, levels.

Folks, health care is one of the very few places where I, personally, want everything maxed out on the GOOD and the FAST fronts. Which means it’s not going to be cheap. Not at all.

Quality care delivered quickly is expensive. And if you think it through, it makes all the sense in the world.

Quality (good) is the result of expensive (not cheap) research, expensive (not cheap) training, expensive (not cheap) equipment, and to be honest, expensive (not cheap) failures. Failure in science is a mainstay. Some things that sound right, simply aren’t. And it costs to take those dead ends. But I would rather the science continue, dead ends or not, than to deal with the awful alternative.

Speed (fast) is a function of a practice that engineers call ‘scaling up’ (VERY not cheap) and a function of medical staff having the most productive aids (not cheap) possible.

Scaling up means having more health care professionals in the business – that means more doctors, more nurses, more administration, more receptionists, more janitors, more orderlies, more hospitals, more mobile treatment and diagnostic trucks. Scaling is a huge cost center (not cheap).

Medical staff having the latest in patient management systems, scheduling systems, massive databases of drug interactions and the very latest medical texts and research… Think of having all the texts of the Library of Congress available on the internet, cross referenced, updated on a second by second basis, with portability and accessability of information for medical pros – Kind of like Google for Medical Stuff. (not cheap) Consider patient records being put online (one of the only things I believe that is a good idea in the current proposed bill) but with no personally identifiable information – the patient has an account number and a PIN (wow, advanced technology eh? I think banks have this all sussed out already) that will authorize a doctor to both access and update their medical records online.

Robert A. Heinlein wrote a book called “The Moon is a Harsh Mistress” – the title indicating that the airless moon is an unforgiving environment because the reality of things like needing to breathe strikes home pretty quickly when you are in vacuum. In this book was the concept of TANSTAAFL (sometimes pronounced ‘Tan-Staffle’), an acronym for “There Ain’t No Such Thing As A Free Lunch“, and he’s right. Anytime you are offered a free lunch, you will end up paying, probably more than the cost of a lunch.

With all the cost, I’ll still take GOOD and FAST when it comes to my healh care – TANSTAAFL. Keep that in mind the next time you are offered something that is good, fast, AND cheap. Because whoever is offering it is lying.

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