Keeping Dad company in the hospital for five
weeks had left me befuddled. How can a facility
featuring state-of-the-art diagnostic equipment
use less-sophisticated information technology
than my local sushi bar? How can the ICU stress
the importance of sterility when its trash is
picked up once daily, and only after flowing
onto the floor of a patient's room? Considering
the importance of a patient's frame of mind to
recovery, why are the rooms so cheerless and
uncomfortable? In whose interest is the bizarre
scheduling of hospital shifts, so that a
five-week stay brings an endless string of new
personnel assigned to a patient's care? Why, in
other words, has this technologically advanced
hospital missed out on the revolution in quality
control and customer service that has swept all
other consumer-facing industries in the past two
generations?

I'm a businessman, and in no sense a health-care
expert. But the persistence of bad industry
practices-from long lines at the doctor's office
to ever-rising prices to astonishing numbers of
preventable deaths-seems beyond all normal
logic, and must have an underlying cause. There
needs to be a business reason why an industry,
year in and year out, would be able to get away
with poor customer service, unaffordable prices,
and uneven results-a reason my father and so
many others are unnecessarily killed.

Like every grieving family member, I looked for
someone to blame for my father's death. But my
dad's doctors weren't incompetent-on the
contrary, his hospital physicians were smart,
thoughtful, and hard-working. Nor is he dead
because of indifferent nursing-without
exception, his nurses were dedicated and
compassionate. Nor from financial limitations-he
was a Medicare patient, and the issue of expense
was never once raised. There were no greedy
pharmaceutical companies, evil health insurers,
or other popular villains in his particular
tragedy.

Indeed, I suspect that our collective search for
villains-for someone to blame-has distracted us
and our political leaders from addressing the
fundamental causes of our nation's health-care
crisis. All of the actors in health care-from
doctors to insurers to pharmaceutical
companies-work in a heavily regulated, massively
subsidized industry full of structural
distortions. They all want to serve patients
well. But they also all behave rationally in
response to the economic incentives those
distortions create. Accidentally, but
relentlessly, America has built a health-care
system with incentives that inexorably generate
terrible and perverse results. Incentives that
emphasize health care over any other aspect of
health and well-being. That emphasize treatment
over prevention. That disguise true costs. That
favor complexity, and discourage transparent
competition based on price or quality. That
result in a generational pyramid scheme rather
than sustainable financing. And that-most
important-remove consumers from our
irreplaceable role as the ultimate ensurer of
value.