Reinstalling the Healthcare OS

The American Healthcare system is broken.

Or, as the geek would say, the OS needs to be reinstalled. If I may coin an analogy here, the American Healthcare system is to Socialized Medicine as Microsoft Windows is to Linux. Now, before you jump down my throat and rip out my innards with your vastly superior Conservative claws, let me elaborate. Linux works. Nobody doubts that. On a small scale, in an ideal environment, where everyone involved knows the system and help is just a Google search away, Linux is the best OS out there. And it’s free. Unfortunately, we don’t live in that world; users break the unbreakable, they know nothing about computers, and they can’t take care of themselves when things go south. Windows isn’t the most stable or cheap OS out there. But it is comfortable, packed with user-friendly features, and if you have a minor problem, it can be solved by most people with basic computer literacy. Unfortunately, there’s a price tag. And it’s not only the money. If you ever have a serious problem in Windows, the back-end infrastructure is so vast and bottomless that even the most grizzled IT pro out there needs help from time to time. There are entire libraries of back-end architecture support tools that less than 1% of the population will ever even look at. Look up WMI on Wikipedia for a great example. Here’s an excerpt from the overview:

In order to unify the management techniques for the sake of simplicity, the DMTF defined CIM to represent real-world manageable entities in a unified way. The CIM object model is an object database model using terms and semantics that are unique to all constructors and software developers. This object model is implemented in a database called the CIM repository.

Based on the CIM model, WMI includes real-world manageable components, available from the DMTF standards with some specific extensions that represent the various Windows components. Moreover, WMI exposes a collection of COM-scriptable objects that allow various applications to take advantage of the management information.

As part of the installation process, most of the Microsoft applications available today (e.g. SQL Server, Exchange Server, Microsoft Office, Internet Explorer, Host Integration Server, Automated Deployment Services) extend the standard CIM object model to add the representation of their manageable entities in the CIM repository. This representation is called a WMI class, and it exposes information through properties and allows the execution of some actions via methods. The access to the manageable entities is made via a software component, called a “provider” which is simply a DLL implementing a COM object written in C/C++. Because a provider is designed to access some specific management information, the CIM repository is also logically divided into several areas called namespaces. Each namespace contains a set of providers with their related classes specific to a management area (i.e. RootDirectoryDAP for Active Directory, RootSNMP for SNMP information or RootMicrosoftIISv2 for Internet Information Services information).

To locate the huge amount of management information available from the CIM repository, WMI comes with a SQL-like language called the WMI Query Language (WQL).

See what I mean?

Windows is shiny and sleek, with an absolutely huge set of tools mostly inaccessible to the average user, and expensive to boot. It puts on a good show; it makes people think they’re being treated to a 5-star hotel when they’re really just staying in a souped up Econo Lodge with free HBO, Continental Breakfast, and a concierge that pretends to care (The Taskbar!!!! It Will Change The World!!!!). No matter how much free food Econo Lodge throws at you, the building is still on the verge of collapsing on you while you sleep. Free HBO doesn’t make up for the cigarette burns in the carpet or the slight stink in your sheets. However, the price of admission isn’t high, you know it when you see it, and you don’t get confused figuring out what to do once you pull into the parking lot.

I believe that’s what our Healthcare system is like right now. The concept is great. The whole triangle of patient-insurance-caregiver is a good model, and it does what it needs to do. However, when it breaks, it breaks hard. The seemingly simple interface of the triangle opens up to be the most complicated geometric object in Euclidian reality, and when something isn’t working, when insurance decides not to follow the triangle and doesn’t reimburse the caregiver, you are left to traverse the insurmountable labyrinth of private insurance to get answers. This leads to inefficient care, inefficient spending, and consumer apathy. The consumer becomes a simple pawn in the complex chess game of coverage, and is forced into premiums and charges that will break the system. This sounds a lot like Vista.

Now, let’s look at Linux. Back to the hotel example, Linux is like a hostel. Yeah, it’s free. But go there alone for the first time without a friend, and you might get raped.

Just sayin’.

There are distributions like Ubuntu that attempt to make the experience user-friendly, but in the end, the terminal will still be the only way to do things properly. If you don’t learn yourself some command-line, you won’t really be using Linux, and your experience will be second-rate at best. There’s an amazing amount of free tools and flexibility in Linux, but unless you know how to get around, or know someone who can teach you, you’re doomed to a bare-bones, barely functional OS, with maybe half of your hardware having the right drivers. The success of Linux is completely dependent on the ability of the user to learn how to get around. Help is out there, but it can be hard to understand and usually depends on your knowledge of other obscure command-line tools. Most users will simply give up and say that they have a working system when in fact they don’t know what they’re missing.

I believe that this is the state of Socialized medicine. Everyone seems to be happy with it, but they don’t know what they’re missing because they don’t bother to try harder. For them, a month wait for a surgery may be awesome, but nobody in America would even consider waiting that long. Sure, there are plenty of people who have learned how to navigate the Socialized medicine system and come out with a great experience, but that won’t be the case for the majority of people. So, does the potential to be a great OS make it a great OS? Does the fact that a healthcare system should work make it a good system?

I know that this analogy is somewhat controversial, as I am impinging on two separate religious flame wars at the same, and I don’t expect everyone to agree with me. This is just a framework with which to understand the questions and the problems. I think I may have some theoretical answers, but I’ll save that for another post. I need to flesh it out a bit more.

P.S. Mac OSX is like the healthcare system of Sweden. They think they’re so special and awesome, but they’re still Sweden. Nobody cares.

Edit: Thanks to the Benjamin at The Daily Harangue for fixing up my graphic. Sorry, I was using MS Paint. I'm old school like that.