HEALTHCARE - JUST IN TIME (JIT) AND
WHAT WE DIDN'T LEARN.
This blog is slightly different. I have included several maps. I was watching the news today and heard a comment that really bothered me. The pundit was talking about how Mr. Romney might be in trouble because he was in office when Mass. adopted healthcare reform and has just lauded the Israeli healthcare system. What bothers me is not whether or not Mr. Romney is in trouble but the inability of Americans (in general) to: 1. put individual items in perspective and 2. to synergize concepts that are taking place in different arenas.
During the late 80's and 90's the business community became enamored with the Japanese logistics system known as JIT. At this time I wrote a paper in graduate school illustrating why the system which was the ultimate expression of a basic management tenet, as implemented in Japan, could not work in the United States. The theory advocated that companies cease spending exorbitant amounts on stock and insist that vendors deliver items "Just in Time" to meet their production schedule. Japan had refined the system to the point that often parts would arrive within minutes of their need on the assembly line. American management became enthralled with the possibility of having none of their financial capital devoted to stock waiting to be used. Unfortunately, JIT became a lodestone around managements neck and faded into oblivion. Why, because a concept that was correct in theory was not attainable in practice. Americans had forgotten that they had logistical differences with Japan.
Japan had literally built its entire production system after WWII. With this advantage they could develop an automobile factory that had a tire manufacturer, a windshield maker, and all the other parts developers within a radius of several miles. Even the most dispersed suppliers were looking at a transportation distance approximately the size of California. The U.S. on the other hand had developed its infrastructure over a period of centuries. The tire manufacturer might be in Dayton while the Auto plant was in California. Japan was benefiting from what the military describes as internal supply lines while the U.S. was more widely dispersed. The Idea of JIT was sound and seeking to limit stock to its minimum has always been "good business". The problem was that U.S. acadamians and managers got swept into believing that they could see the same returns to scale that the Japanese were realizing. Instead of setting realistic objectives they set goals that were destined to fail.
So, how does this apply to Healthcare. We didn't learn our lesson and then those of us that did failed to apply it across disciplines. As the maps will show you there is a two, no actually a threefold difference between the countries of the United States, Canada, and Israel. I added Canada because it is often quoted as an ideal model. If you look closely you will note that the populations of the three countries are enormously different. This in itself amplifies the logistical requirements and provides much more fertile ground for the U.S. to have waste and fraud in its system. Notice also that the population density is extremely focused in both Israel and Canada. While Canada is comparable in land mass it is not when examining its ability to internalize its health care facilities and assets. Canada has essentially three (3) major distribution centers to service its entire population. Israel is so small and so concentrated that health care is virtually available for all citizens with all specialties within easy reach of every citizen. The U.S. is on the other hand a different story.
The United States has a land mass comparable to Canada but has a population dispersion level that requires exceptional levels of medical facilities and support compared to Canada. Canada cannot deliver the same coverage that is found in Israel for the same reason. Look at it this way, if a neurosurgeon was needed for every 100,000 people Population alone would demand more neurosurgeons in the U.S. But, it also means that 100,000 people must be able to access these neurosurgeons which means that to ensure universal coverage you must have some neurosurgeons servicing those areas where there are only 25,000 people. In a case such as Israel or a country with its population located in only a few major areas the requirement is less taxing. However, in a country as widely dispersed as the U.S. with thousands of population centers exceeding 25,000 individuals and these are spread the width and length of the country's borders with Alaska and Hawaii presenting true outliers. At this point we have not even addressed the areas that are not population centers but still need the universal coverage.
I could turn this into a dissertation but that wouldn't solve any problems. We, our leaders, and our academics must begin to analyze our needs based upon the reality of our logistic differences. We cannot look at Israel, Canada, Massachusetts and assume that the model is transferrable to the nation as a whole. Can we have national healthcare? Yes, but it will be a far cry from the systems used in these other countries and if we do not approach it as a unique problem we will spend vast amounts of our national treasury and incredible amounts of time trying to make a silk purse out of a sows ear.
SO SAY'S GRUMPY