Editor's blog 24 July 2008 - Is healthcare an artisan product or an industrial one?
This afternoon, while I was tasting some wines in Meursault and Volnay, I was having 'that discussion' with the winemakers about how crap New World wines are. Now I say discussion, but actually it's the receiving end of a lecture (it's almost like they're blogging at me or something ...)
No, the lecture is a joke anyway. These are by no means stupid people: they recognise that there are talented artisan winemakers in every wine-growing part of the world.
But it still gives them a nationalistic boost to feel that all New World wines are simply industrial products, engineered for homogeniety - which will never have the local roots and annual variation of a splendid wine like this 1er Cru Volnay ... Ils ne sont pas des artisans, pas comme nous
And there I was sat, as I am now, thinking about the relevance to healthcare.
You see the dedication I have to the cause?
Artisans make small amounts of locally-specific, maker-specific high-quality and therefore expensive products. They usually work for themselves, until the reputation of their brands starts to become so big (or overblown) that it attracts the interest of hedge fund companies - but this is still rare.
They may choose to plough a niche if that is their preference: many inherit the estate, and traditions can be strong. They may choose to limit their market, and to be inaccessible to the curious. Cost-awareness is paramount, but prices can rise in a good vintage or after a good review.
Industrial producers know that it's about volume and consistency. They buy their inputs from anyone with grapes (in the case of a wine) of a sufficient quality and quantity who can meet the price. They will often go for very high standards of hygiene, perhaps in unromantic settings like prefab-and-concrete warehouses.
Cost-awareness is paramount, but it is often connected with keeping the product at a price that the mass market suppliers (such as supermarkets) will pay for the brand.
Once upon a time, most healthcare was, de facto, artisanal. There were few makers (herbalists, wizards and barber surgeons); smaller and less transient communities; and there was of course a socially-enforced faith in an afterlife to help give a Viagra charge to your stiff upper lip.
There was scarce choice; mistakes were buried six feet under; it must all have been very bracing.
Now healthcare is a big business, representing around 10% of GDP in most developed economies. And the US is something else again, more's the pity. Populations are transient, more knowledgable, more demanding and with much less faith in an eternal hereafter if the good doctor slips up. We expect national quality standards; we want less variation in outcomes; and we are highly concerned about costs. (And we would like the latest and best drugs now, please.)
The work of art in the age of mechanical reproduction
One of the most splendidly wrong things you could possibly read is Walter Benjamin's essay, The work of art in the age of mechanical reproduction.
I could damn it for you quickly and just say that it's a hugely influential text on the postmodernist movement.
Or I could damn it more accurately, and quote Benjamin's comment that "creativity and genius, eternal value and mystery (are) concepts whose uncontrolled (and at present almost uncontrollable) application would lead to a processing of data in the Fascist sense".
Benjamin basically intends for all art to be useful for revolutionary Communist purposes. Wonderful Stakhanovite stupidity.
Note also the reference to Taylorism, or as it is also sometimes known, 'scientificmanagement'.
We are back to industrial mass production - a fact of life in the vast bulk of contemporary healthcare.
Taylor and his -ism have had a bad press. However, many forget that he was the first management theorist to notice that fatigue causes worker inefficiency. He also believed that scientific management cannot work unless the worker benefits as well as the manager, shareholder and owner.
Doesn't that sound quite an enlightened idea?
And are we not overdue for thinking about whether and how healthcare should balance the artisanal and the industrial?