Exponential Futility
By Craig B. Garner
Founder
Garner Health Law Corporation
Original Publish Date: February 4, 2025
“To the mind that is still, the whole universe surrenders.” -- Laozi
Humanity Is Special
Humanity has created a special place in the cosmos. Within the universe as we understand it, each of the 8.2 billion individuals on this flat Earth exists as the functional equivalent of a spec on the back of a 150-ton, 98 foot blue whale, which in turn is just another spec on an even larger animal, magnified by some exponent of a googolplex (1 followed by 100 zeros). Yet even knowing its rightful place in the universe, medical science saw fit to identify a specific mental disorder, DSM-301.81 (narcissistic personality disorder), defined as a pervasive pattern of grandiosity. DSM-301.81 may be proof that sentient beings do not exist beyond the firmament, as that which happens in and around our minds consumes all kinetic and/or possible galactic energy.
Fascinating as it may sound, this energy does little to ease the fear of a patient just admitted through the emergency department at a hospital near you. Fortunately for that same patient, he or she exists within a comprehensive regulatory infrastructure that affords the highest level of privacy in practically any industry, confers an absolute entitlement to emergency medical treatment, insists upon the delivery of a standard of care unavailable until decades into the future, and prohibits myriad ways in which reasonable financial responsibility exists. Welcome to health care 2025, one of modern society’s most cherished institutions that edges closer and closer to cataclysmic failure each day.
How Did We Get Here?
Just over a century ago hospitals acted like staging areas for cemeteries rather than epicenters for healing. The precursor to a modern-day hospital welcomed the destitute and poor in their final days while those with even modest financial resources received health care from the comforts of home. Practical advances such as an emphasis on reducing infections through clean water and a sterile environment, coupled with discoveries in the science of medicine such as penicillin in 1928, cast a bright light on the importance of the hospital in the twentieth century. Hospitals expanded in number from under 1,000 to more than 6,000 over the next three decades, based in large part when Congress passed the Hill-Burton Act in 1946. This confirmed the hospital’s significance in the United States, which ultimately reached sacrosanct status by the time Congress passed Medicare in 1965.
Today, hospitals expand outside the four walls of their main structure into nearby communities, offering myriad treatments that focus on efficacy and efficiency as a means to combat physical and mental illness. In California, a 1994 earthquake with its epicenter in the City of Northridge ultimately resulted in the construction and/or improvements of new hospital buildings, many of which are equipped with cutting-edge technology and an army of highly skilled health care practitioners trained to maximize such an infrastructure as it delivers health care to patients. While the 2020 global pandemic presented a setback to patient confidence in the hospital institution, the collective deficiency in society’s short-term memory has mostly corrected such fears.
A Hospital Patient’s Place in the Universe
One hospital patient represents about 1e-9% of the world’s population, which fits within the range of that spec on the back of a blue whale mentioned above. In the context of the estimated 200 billion to 2 trillion galaxies in the observable universe, any if not all hospital patients maintain an existential insignificance today. When extrapolating this concept over time, past and future, the average 4.7 day hospital stay falls short in comparison to our planet’s age, estimated at 4.5 billion years.
When removed from the existential and placed into reality, however, society covets the care and treatment of practically all hospital patients. Very few examples in society come close to the scope of sympathy, empathy, and overall concern for a hospital patient, irrespective of the reason for the stay. In many ways, the combination of patient and hospital extracts the very best from the general population. Should science decide one day to study the internal chemical reaction created by this unexpected response when combining the words “hospital” and “patient” in the same sentence, perhaps the by-product will serve as a modern day Thorazine and force once again an epic shift in the treatment of mental health illness.
Alternatively, such a consumable product with its origin in the purest of ingredients runs the risk of abuse while becoming a source of contention. This dynamic, too, is an inherent part of the human condition, and for as long as our species exists on Earth, there remains the risk of exploitation and compromise. From isolated personal vendettas to global warfare, living across the proverbial street from our common desire to protect the hospital patient is humanity’s insatiable desire for more. Dystopian in nature, this primordial instinct bypasses the concept of “zero-sum game” and proceeds directly to an unhealthy shift in balance. In the context of a hospital setting for example, the existence of organ doners and an unofficial black-market to obtain organs provides a reasonable comparison. As much as society means well, its capacity to do bad perseveres.
What To Do About Health Care?
On a long enough timeline, no calculation of deployment in resources avoids the inevitable conclusion that health care is the ultimate zero-sum game. While not as obvious as the “Carousel” from the 1976 film Logan’s Run, at some point in the future, all 8.2 billion living souls on this planet will no longer exist, at least in the corporeal form. Still, the amount of financial and other resources consumed by health care needs each year is staggering, but arguably worthwhile as it often relates to matters of life and death.
At the same time, the federal government estimates that as much as twenty percent of its annual health care budget disappears through fraud, abuse and waste. Add to the mix the perception of the health insurance industry, a leading force in the ultimate delivery of health care around the nation, and its recent existence as a literal target for those disenchanted with the system. As the battle between patients, providers and payers rages on, it remains an absolute failure when a health care system with the level of sophistication that exists today fails to deliver to each and every patient in need. Something is broken, yet few have the capacity or willingness to isolate the problem.
Even the staunchest supporters of Libertarianism must concede that society generally lacks the ability to self-regulate. The recent disaster in California’s Pacific Palisades presents yet another example of how kindness and conflict exist side-by-side. The generosity directed toward those victims from the Pacific Palisades wildfire has been epic, yet there is still a pressing and sometimes toxic effort for individuals to locate new homes, place displaced children in new academic institutions, and battle with government agencies and insurance companies alike to be made whole. To be sure, blame does not fall upon the victims from these historical blazes, but rather the totality of the situation is simply a logical product of modern day society and how it exists today.
Maybe Logan’s Run Had a Valid Point
If an expanded time continuum renders health care as an exercise in zero-sum game, it is worth reevaluating at least the relationship between hospital and hospital patient on one side with society on the other. This idea does not advocate any mechanism like Carousel in Logan’s Run, but at the same time it does suggest examining how health care provides medical care to patients in their last year alive. While any proposed solution to improving health care is prone to controversy, acknowledging that the system is generally broken is not unreasonable.
Few Congressional leaders will incorporate into any health care platform individual insignificance at a cosmic level. Nor will these same leaders, let alone family and friends of a hospital patient, acknowledge that death is little more than a temporal inconvenience for the living. Perspective and context, however, often provide an infusion of clarity into a kerfuffle of any magnitude.
Ultimately, to seek a solution one must identify the problem. To identify a problem, one must try to remove personalization and blame. To remove personalization and blame, however, one may need to seek a certain degree of enlightenment that often remains elusive. Instead, society far too often engages in the futility, which in turn becomes attached to one or more individuals. Oddly enough, fixing health care while it exists in the middle of its existential and operational crisis may require more than money and regulatory reform. Health care’s solution may likely be spiritual in nature and attainable in part through an adequate dose of reality and perspective. This includes some recognition of our limited time on this third horizontal surface from the sun, not to mention the degree to which our actual existence is both fragile and generally insignificant. Such a solution, however, may be a hard pill to swallow.
Craig Garner is the founder of Garner Health Law Corporation, as well as a healthcare consultant specializing in issues pertaining to modern American healthcare. Craig is also an adjunct professor of law at Pepperdine University School of Law. He can be reached at craig@garnerhealth.com.