The GUTH in a Nutshell

As it turns out, we can represent the healthcare universe with a simple, two-dimensional graphic model, as shown in this figure.

This model takes into account:

Who makes healthcare decisions (the horizontal axis in the figure)
Whether those decisions are of high or low quality (the vertical axis)

Within the universe defined by this model, we can fully characterize the behaviors of any healthcare system we could plausibly devise.

On the horizontal axis, we ask if healthcare decisions are made by the individuals most directly affected by them (the patients and their doctors) or, instead, if they are under the control of some centralized authority (such as the federal government or giant insurance carriers). On the vertical axis we ask if the decisions are of high quality, based on good, solid, scientific evidence or if they are of low quality, made on some other basis, such as political considerations, intuition, superstition, or emotion.

These two axes (individual vs. centralized decision-makers, and high-quality vs. low-quality decisions) divide the healthcare universe into four quadrants. Each of these four quadrants carries with it a set of inherent properties that largely determine the behavior of any healthcare system operating within that quadrant. This four-quadrant model of the healthcare universe, along with four corollaries that we will derive from it, constitute the GUTH.

In this brief discussion of the GUTH, I will give a general overview of the GUTH and attempt to demonstrate its potential. To this end, I will show that:

Until recently, the American healthcare system operated in Quadrant IV of the healthcare universe.
Operating in Quadrant IV was always an unstable and time-limited proposition; there was never any possibility that we could stay there.
The momentum of change has moved us into Quadrant III.
The defining characteristics of Quadrant III explain the strange behavior of today's healthcare system.
By understanding where we are on this healthcare landscape and how we got here, we can see how to advance to a more favorable position (Quadrant I or Quadrant II).