The Simpsons Explain Healthcare

 Happy New Year!  We’re starting 2022 full of hope and renewed optimism. Oh, wait; not so much. We’re not only still in a pandemic, the Omicron variant is the most infectious one yet.  Daily cases are setting new records. Our hospitals are full again. Our beleaguered healthcare workers – the ones who haven’t already thrown in the towel – are at their breaking points.  Two years in, and we still don’t have enough tests. We’re in the greatest public health crisis in a century, yet our legislators are taking power away from public health officials, and their angry constituents are forcing many of those officials to quit. We have effective vaccines, but millions still refuse to take them.

The Simpsons – specially, Homer -- has the right word for this: D’oh!

Homer Simpson Credit: Groening/Disney

Even those who are not Simpsons fans – and I don’t know who these people are – are probably aware of the show. At over 700 episodes and 33 seasons, it is the longest running American animated series, sit-com, and primetime television series.  The titular head of the family is the hapless, impulse-driven Homer, who is most associated with the expression “D’oh.”

Merriam-Webster defines “Doh” as an interjection “used to express sudden recognition of a foolish blunder or an ironic turn of events.”  One analysis found that if Homer were a real person, his various healthcare experiences over the years would have cost him over $143m, giving him plenty of opportunity for D’ohs.

D'oh!

Got a medical bill that seems outrageously high?  D’oh!  Your insurance won’t cover some procedure that you or a family member needs?  D’oh!  Can’t afford to see a doctor, fill a prescription, or buy insurance? D’oh! Have to wait days, weeks, even months to get an medical appointment?  D’oh! Have to carry your health records around on a CD or paper because your doctor’s/health system’s EHR doesn’t communicate with your other doctors’/health systems’ EHRs?  D’oh!

You have your own stories.  You’ve had your own frustrations.  You may even have your own favorite expression (or expletive) to use when running up against the healthcare system. But I prefer “D’oh,” because, as with Homer Simpson, at the end of the day we have ourselves to blame for the mess we’re in.

There’s another Simpsons clip that may help explain. You can watch the clip below, but, briefly, Homer gets his arm stuck in a vending machine trying to get a free soda. Emergency personnel are summoned, and they literally are about to cut his arm off when an EMS worker realizes that the problem is that Homer has refused to let go of the soda can. 

The question for us is, what is the metaphorical soda can in our healthcare system that we so tenaciously continue to hold onto, even at the risk to our health and lives?

Some might say it is our failure to implement universal healthcare, as almost every other developed country has done. It’s baffling that, even after ACA, we’ve got close to 30 million people without coverage, and there’s no political will to change that. It’s worse than baffling – it’s horrifying – that 12 states still haven’t expanded Medicaid, as ACA allowed/paid for, which would protect their most vulnerable citizens. But, even in states that have expanded Medicaid, affordable coverage is available to everyone, yet not everyone takes it.

Others might say it is our continued reliance on fee-for-service payment, which critics believe encourages overuse. We’ve tried capitation, we’re still trying value-based payment, and yet fee-for-service continues to dominate. But that doesn’t make our healthcare system different than most other countries’ systems.

Maybe it is that we act as though quality is a given: my doctor is the best, our hospital is just fine for any care, when, in fact, quality of care varies greatly and it very much matters what care you get and from whom you get it. “Quality” in healthcare is surprisingly amorphous; similar to Justice Potter Stewart’s belief about obscenity: we think we know it when we see it. We don’t. But, again, that’s true in every healthcare system.

Credit: Caitlin Hillyard/KHN illustration; Getty Images

A strong argument can be made that the foolish thing we persist in is allowing so many payors to each negotiate its own rates with health care providers. It’s well documented that Americans pay far more for healthcare products and services than anywhere else. We don’t have too many doctors, we don’t have too many hospitals, we don’t get too many procedures or tests, we don’t take too many prescriptions. We just pay way too much each of the times we do any of these.  As Dan Munro, author of Casino Healthcare, likes to say, we don’t need single payor, we need single pricing.  But, then again, we don’t have that kind of single pricing for anything else – not food, not energy, not water, or any other essential products and services.

And therein, I think, lies our real problem, the soda can to which we persist in holding on to no matter what. America preaches individualism, of the ability for anyone to “make it” here.  We claim to treasure self-reliance, and look skeptically at government help (except, of course, Social Security, Medicare, or disaster relief). 

We know we should lead healthier lives, but most of us don’t.  We know we should listen to the experts, including our doctors, but as the current pandemic is proving, too many of us don’t. We know healthcare and health insurance are way too expensive, but we continue to shrug at their costs. So we have an out-of-control healthcare system – and, for similar reasons, exploding deficits, crumbling infrastructure, and climate change that will soon drastically change our existence.

D’oh, indeed. 

The Simpsons is a cartoon.  It’s satire. Homer isn’t going to have to pay that $143m. Homer won’t suffer any consequences past the end of the episode. We’re not so lucky. We have to live with – or die from – the consequences of the foolish blunders we make or the ironic turns of events we find ourselves in, especially when it comes to healthcare

It’s 2022.  Let’s stop accepting the unacceptable.  Here’s what our New Year’s Resolution should be: no more healthcare D’ohs.