{"id":3835,"date":"2025-02-19T07:23:00","date_gmt":"2025-02-19T07:23:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=3835"},"modified":"2025-02-19T07:23:00","modified_gmt":"2025-02-19T07:23:00","slug":"patients-are-npcs","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=3835","title":{"rendered":"Patients Are NPCs"},"content":{"rendered":"
\n<\/div>\n

By KIM BELLARD<\/p>\n

I found a new way to think about patients in an opinion piece by Ezra Klein: they\u2019re NPCs. For those of you unfamiliar with gaming, NPCs are those characters in video games that aren\u2019t controlled by live players; they\u2019re part of the game, serving as background for the actions the actual players take.<\/p>\n

Not a very flattering metaphor.<\/p>\n

Mr. Klein\u2019s article is neither about healthcare nor gaming, but about politics: The Republican Party\u2019s NPC Problem \u2014 and Ours<\/em><\/a>. <\/em>Conservatives, Mr. Klein explains, accused liberals of being NPCs \u2014 passive, conformists, deferential \u2013 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:<\/p>\n

It\u2019s a genuine failure of Democrats that they didn\u2019t 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\u00a0basically nothing<\/a>\u00a0to show for it by November of 2024? How did it get $7.5 billion for electric vehicle chargers but build only\u00a0a few hundred<\/a>\u00a0chargers by the end of the term?<\/p>\n

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.<\/p>\n

Marc J. Dunkelman makes a similar argument in The Atlantic<\/em>: How Progressives Broke the Government<\/em><\/a> <\/em>(an adoption of his new book Why Nothing Works: Who Killed Progress\u2013And How to Bring It Back<\/em><\/a>). <\/em>Here are a couple of the relevant passages, aimed at the Progressive movement:<\/p>\n

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\u00a0good\u00a0<\/em>the government might do in service of ensuring that it won\u2019t do\u00a0bad<\/em>. And that\u2019s driven well-intentioned reformers to insert so many checks into the system that government has been rendered incompetent.<\/p>\n

At present, progressives are too inclined to cut public authority off at the knees. And that\u2019s why they so often feel like they can\u2019t win for losing. Their cultural aversion to power renders government incompetent, and incompetent government undermines progressivism\u2019s political appeal.<\/p>\n

America can\u2019t build housing. We can\u2019t deploy high-speed rail. We\u2019re struggling to harness the promise of clean energy. And because government has failed in\u00a0all\u00a0<\/em>these realms\u2014because confidence in public authority has waned through the years\u2014progressives have found it difficult to make a case for themselves.<\/p>\n

What does any of this have to do with healthcare, much less NPCs? It\u2019s 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<\/a>, of the quality of care<\/a>, and especially its costs<\/a>. \u00a0Americans hate Big Pharma<\/a>, we hate health insurers<\/a>, and our trust in doctors and hospitals has plummeted<\/a>, especially since COVID.<\/p>\n

<\/span><\/p>\n

U.S. researchers develop innovative, life-saving treatments, but we often can\u2019t 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. \u201cComplicated\u201d is perhaps the kindest description one could use for our healthcare system.<\/p>\n

Every healthcare organization claims to \u201cput patients first.\u201d \u00a0It\u2019s all about the patients. Except, of course, it isn\u2019t. Healthcare has been invaded by private equity<\/a>, 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<\/a>, and if you don\u2019t believe that, ask your local hospital how many patients it has sued for nonpayment<\/a>.<\/p>\n

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 \u201cfixed\u201d anything. Tell that to the residents of the ten states that have still not expanded Medicaid<\/a>, or to the twenty million who would lose Medicaid coverage under proposed House Medicaid cuts<\/a>. Tell that to the millions of Americans whose bankruptcy is directly tied to their medical debt<\/a>.<\/p>\n

Who would put up with all this? NPCs, of course.<\/p>\n

The \u201clive\u201d 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\u2019 money. The game isn\u2019t about our health; the game is about returns on investment. If you don\u2019t believe that, you probably still believe Facebook is all about connecting the world and Google is all about making the world\u2019s information accessible. We\u2019re the product; we\u2019re in NPCs in their game.<\/p>\n

We need a healthcare system that works for patients, one that treats us like individuals with unique challenges, not like nameless NPCs.<\/p>\n

Our government \u2013 at the state, local, and federal level \u2013 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\u2019re just an NPC in their world.<\/p>\n

We need leaders who won\u2019t 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.<\/p>\n

Mr. Dunkleman argues:<\/p>\n

Populism takes hold not when democracy works well, but rather when it doesn\u2019t 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\u2019s north star.<\/p>\n

Similarly, conservative Bret Stevens, in the most recent The Conversation<\/em><\/a> with liberal Gail Collins, asserts: \u201cA better motto for Democrats, I think, is \u201cEffective government,\u201d 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 \u201cefficiency.\u201d<\/p>\n

That needs to be more than a motto, and not just for Democrats. \u00a0Healthcare would be a great place to start.<\/p>\n

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented\u00a0<\/em>Tincture.io<\/em><\/a>, and now regular THCB contributor<\/em><\/p>","protected":false},"excerpt":{"rendered":"

By KIM BELLARD I found a new way to think about patients in an opinion piece by Ezra Klein: they\u2019re NPCs. For those of you unfamiliar with gaming, NPCs are those characters in video games that aren\u2019t controlled by live players; they\u2019re part of the game, serving as background for the actions the actual players…<\/p>\n","protected":false},"author":0,"featured_media":3834,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-3835","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/3835"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3835"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/3835\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/3834"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3835"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3835"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3835"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}