If you have teenage kids, you end up watching a lot of MTV or you have nothing to talk to your children about. My kids are both in college now, but I have watched a lot of MTV in my time. My favorite show of the moment is “Pimp My Ride”. The show is in the genre of all makeover reality shows. In this case a rapper host introduces a poor kid and their beaten up old car (the ride). The car is taken from the young adult and transformed by a team from West Coast Custom (a body shop and customization company in LA).
Each episode shows a different kid and a different car: clapped out Pintos, beaten up Suburbans, and a plethora of ugly, weird, old and dilapidated camper/truck hybrids. The process is always the same: they strip the car’s interior and install an unbelievable array of stereo equipment (woofers and sub-woofers included), video displays (even laptops) and the whole thing is topped off with an amazing paint job in vibrant blue or dazzling yellow, topped up with custom painted flames on the side. They never seem to do anything to the engine, drive train, or chassis of any of these vehicles. At the close of each episode the youngster is shown the transformed vehicle that has been “pimped” and they can never contain their excitement. They are deeply grateful.
The prevailing vision of quality in American healthcare is “Pimp My Ride”. We take a really bad chassis and engine and bolt on unbelievable amounts of high technology on a frame that is tired, old and ineffective. We spend extravagantly on buildings, machines, drugs, devices, and people at West Coast Custom Healthcare. The people who own the rides are very grateful because they don’t have to pay for it in a high deductible catastrophic coverage world, once you are over your deductible and ensconced in an American hospital the sky’s the limit. It all looks great, has a fantastic sound system, and nice seats but it will break down if you try and drive it anywhere.
Pimp my Ride is a perfect metaphor for the healthcare system as a whole, but it also applies to the individual patient. We take the morbidly obese, the terminally ill, and the very old and throw fabulous technology and unbelievable paint jobs at the human subjects. (Apparently, a young resident at Harvard made the observation on NPR about treating the terminally ill that it was like “Pimp My Ride”. I am not above stealing ideas from my friends at Harvard, but in this case it was great minds think alike).
From the system as a whole to the treatment of individual patients, we need to break the “Pimp My Ride” mentality. First, we need to transform the basic engine and drive train. We need a new system of medical care delivery and the reimbursement system to support it.
Second, we need to examine what level of technology, facilities, services and intensity of care yields the optimal outcome. We keep throwing money and technology at problems without asking basic questions: what should be done, how much, for whom, when?
Third, we need some intelligent consumer engagement. The kid who gets his beater fixed by MTV could care less how much it costs. Just as we patients could care less about the cost of excessive esoterica we receive in hospital. While I have been a critic of dumb-cost shifting and simplistic high deductible health plans, I do believe we have to engage the consumer intelligently in understanding and participating in the financial consequences of high technology interventions that are marginally effective.
Finally, we have to break the public perception that the medical equivalent of a good paint job and a fancy sound system makes for good quality. The Institute of Medicine and their followers have a long way to go because the prevailing vision of quality healthcare among most doctors and most patients is closer to “Pimp My Ride” than to the IOM’s vision.
Ian Morrison is an author, consultant and futurist based in Menlo Park, California.