By KIM BELLARD
I found a new way to think about patients in an opinion piece by Ezra Klein: they’re NPCs. For those of you unfamiliar with gaming, NPCs are those characters in video games that aren’t controlled by live players; they’re part of the game, serving as background for the actions the actual players take.
Not a very flattering metaphor.
Mr. Klein’s article is neither about healthcare nor gaming, but about politics: The Republican Party’s NPC Problem — and Ours. Conservatives, Mr. Klein explains, accused liberals of being NPCs — passive, conformists, deferential – whereas they were the live players, willing to take chances and make things happen. He goes on to explain why this is not at all accurate, especially in the Congress, but this paragraph is what really struck me:
It’s a genuine failure of Democrats that they didn’t put more energy into making the government faster and better when they were in charge. How did the Biden administration pass $42 billion for broadband in 2021 and have basically nothing to show for it by November of 2024? How did it get $7.5 billion for electric vehicle chargers but build only a few hundred chargers by the end of the term?
i.e., Democrats had some good ideas, took action to try to make them happen, but failed in the delivery. Good intentions matter, but are necessary, not sufficient.
Marc J. Dunkelman makes a similar argument in The Atlantic: How Progressives Broke the Government (an adoption of his new book Why Nothing Works: Who Killed Progress–And How to Bring It Back). Here are a couple of the relevant passages, aimed at the Progressive movement:
Progressives are so fearful of establishment abuse that reformers tend to prefer to tighten rather than loosen their grip on authority. The movement discounts whatever good the government might do in service of ensuring that it won’t do bad. And that’s driven well-intentioned reformers to insert so many checks into the system that government has been rendered incompetent.
At present, progressives are too inclined to cut public authority off at the knees. And that’s why they so often feel like they can’t win for losing. Their cultural aversion to power renders government incompetent, and incompetent government undermines progressivism’s political appeal.
America can’t build housing. We can’t deploy high-speed rail. We’re struggling to harness the promise of clean energy. And because government has failed in all these realms—because confidence in public authority has waned through the years—progressives have found it difficult to make a case for themselves.
What does any of this have to do with healthcare, much less NPCs? It’s this: we talk a good game about health care, especially Democrats, but we consistently fail to deliver. Pick your poll: Americans are critical of the healthcare system in general, of the quality of care, and especially its costs. Americans hate Big Pharma, we hate health insurers, and our trust in doctors and hospitals has plummeted, especially since COVID.
U.S. researchers develop innovative, life-saving treatments, but we often can’t get them to the people who need them most. U.S. produces miraculous prescription drugs, but we pay far more for them than anywhere in the world. Healthcare professionals and institutions urge us to get preventive care, to seek care when needed, and to go to the ER in a crisis, but put us in a queue when we try to do any of those. “Complicated” is perhaps the kindest description one could use for our healthcare system.
Every healthcare organization claims to “put patients first.” It’s all about the patients. Except, of course, it isn’t. Healthcare has been invaded by private equity, which offers no pretenses about its priorities. If your health care or health insurance is delivered by a publicly traded company, it can say all it wants about patients but its mission is to deliver for its shareholders. Even supposed non-profit healthcare institutions are increasingly acting like for profits, and if you don’t believe that, ask your local hospital how many patients it has sued for nonpayment.
Democrats tout Obamacare as evidence of improving the healthcare system, and it is a great improvement over what it was before, but no one believes it “fixed” anything. Tell that to the residents of the ten states that have still not expanded Medicaid, or to the twenty million who would lose Medicaid coverage under proposed House Medicaid cuts. Tell that to the millions of Americans whose bankruptcy is directly tied to their medical debt.
Who would put up with all this? NPCs, of course.
The “live” players in the healthcare system are the ones making money; patients are the means to that end. We may be the ones suffering, but that suffering makes other parties’ money. The game isn’t about our health; the game is about returns on investment. If you don’t believe that, you probably still believe Facebook is all about connecting the world and Google is all about making the world’s information accessible. We’re the product; we’re in NPCs in their game.
We need a healthcare system that works for patients, one that treats us like individuals with unique challenges, not like nameless NPCs.
Our government – at the state, local, and federal level – is not delivering. Our major institutions are not delivering. And our healthcare system is most definitely not delivering. I have to modify all that; if you are in the 1%, things are pretty good. Otherwise, though, you’re just an NPC in their world.
We need leaders who won’t just talk a good game but play it well. Last year Democrats campaigned as though health care meant abortion access, transgender care, and capping prescription costs (e.g., transferring them to the insurer, and into premiums). Not bad goals, but not getting at root problems either.
Mr. Dunkleman argues:
Populism takes hold not when democracy works well, but rather when it doesn’t deliver. No amount of righteous sanctimony can substitute for the political benefits of making public authority serve the public interest. That should be the progressive movement’s north star.
Similarly, conservative Bret Stevens, in the most recent The Conversation with liberal Gail Collins, asserts: “A better motto for Democrats, I think, is “Effective government,” which is primarily about delivering the services people need or expect and not just about saving money, which seems to be the central criterion of “efficiency.”
That needs to be more than a motto, and not just for Democrats. Healthcare would be a great place to start.
Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor
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