How can we escape Quadrant III? 

Denying the inevitability of healthcare rationing ultimately pushes us into Quadrant III. That is, it is mass self-deception that makes covert rationing necessary. The same self-deception makes covert rationing possible. For, not seeing all the widespread rationing behavior - which is quite apparent all around us - requires a willful failure to see it. Covert rationing utterly depends on this willful self-deception.

This observation has important implications. When motivated individuals concerned with their own wellbeing acknowledge that they are navigating a healthcare system founded on covert rationing, the healthcare system can no longer practice covert rationing against them. Covert rationing requires that patients remain passive and compliant, trusting that their doctors, the insurers, and the federal authorities - but especially their doctors - have their individual welfare at heart, will do right by them, and will tell them whatever they need to know. Patients are strongly encouraged by society to trust their doctors and their health plans, and traditionally they have willingly done so. Indeed, when such "ideal" patients notice activities and behaviors that seem contrary to their best interests, they usually attribute those events to aberrations, mistakes, inadvertent inefficiencies, or just someone having a bad day. They might sue someone for malpractice, but it never occurs to them that these events are systematic and even intended.

On the other hand, for those who are appropriately suspicious during each and every encounter with the healthcare system and who entertain the possibility that a chief goal of their doctors, the insurers, and the federal authorities may not be so much to improve their individual health but to avoid spending too much money on them, covert rationing becomes much more difficult to pull off. If a critical mass of citizens were to take this attitude, each one acting in enlightened self-interest, then covert rationing as a national modus operandi would become impossible. If enough individual citizens were to see the light, the healthcare system could no longer operate in Quadrant III.

Knowledge is power

Intelligent patients who understand that covert rationing is occurring and that they can no longer rely on their doctors or their insurers to do what is right for them know that they need appropriate knowledge to protect themselves from the dangers of hidden rationing. Covert rationing depends on patients trusting their doctors to be the main, and preferably only, source of healthcare advice. If their doctor doesn't tell them about it, the paradigm goes, it doesn't exist (which, is why controlling physician behavior is essential to a healthcare system based on covert rationing). Knowledgeable patients wreck covert rationing.

Becoming sufficiently knowledgeable is difficult. Patients are trying, though. American adults are going to the Internet by the tens of millions to find out what their doctors are supposed to be telling them and doing for them. This quest for knowledge is difficult, because so much contradictory, incomprehensible, and just plain wrong information abounds. Even reliable sources cannot tell them whether the information applies specifically to them.

Can patients become sufficiently empowered to block covert rationing? Yes, they can. Looking at the healthcare system historically, it seems likely that many of them will. For we are in the midst of a revolution in information technology that is radically changing every economic sphere it touches. This revolution is just beginning to affect the healthcare system.

A hallmark of the information revolution is that it puts the end user in direct contact with the source of products and services, thus eliminating or marginalizing the middlemen (those who traditionally served as high priests of data, guarding the information that was too sacred or too complex for the small minds of the masses and doling it out, piecemeal, in exchange for appropriate consideration). Examples of formerly powerful, now displaced middlemen include the medieval Church (violently opposed to laymen having direct access to the word of God), stock brokers, music publishers, travel agents, real estate agents, and educators.

Healthcare has been relatively impervious to the information revolution. Here, the high priests of data mongering include doctors, managed care organizations, and the government. All three groups see the information revolution coming but seem confident they'll be able to manage it. They are anxious to have the data themselves but intend to keep it locked up and out of sight (they all agree that medical information is far, far too complex for mere patients to grasp, and so it is clearly in the patients' best interest for the experts to husband that data for them).   They'll interpret the data and parse it out to the patients on a need-to-know basis, thank you. And before it's distributed, it can be spun to support covert rationing.

The middlemen here are fighting history. They're also fighting the growing demands of patients, who sense they've been marginalized by the healthcare system (though they don't yet realize how systematically they have been marginalized), and who-based on their experience in other economic spheres-don't understand why they can't have the information they need to guide their own healthcare. The elderly patients that doctors see today may not yet have this attitude, but many aging boomers do. In ten years the demand by patients for empowering information will be much greater than it is today.

This analysis shows what seems like a pretty good way to make some big bucks in healthcare while simultaneously saving lives: Figure out how to empower patients. Any enterprise that can supply patients with clear, correct, relevant, personal, and specific knowledge that enables them to protect themselves and their loved ones within our hostile healthcare system will endear itself to those patients. Furthermore, anyone supplying such knowledge will be feeding a growing need for more. People's desire for the information to manage their own healthcare and the means to act on that information will become more than just a desire-it will become an expectation. A massive business opportunity awaits.

Three points bear repeating:

1) Individuals who recognize that the healthcare system operates under a model of covert rationing can immediately take steps to prevent themselves and their loved ones from being victims of that rationing. It is hard to covertly ration against enlightened patients.

2) Once a critical mass of the population becomes so enlightened, Quadrant III healthcare will no longer be feasible.

3) Given the history so far of the information revolution and given the information-seeking behavior of a growing proportion of American patients, the enlightenment that will render Quadrant III healthcare impossible seems inevitable.

Thus does the GUTH finally lead us to a place that a while ago may have seemed almost incomprehensible. It leads us to a place of optimism or, at least, relative optimism. There may be a path out of Quadrant III, and it is a path we're likely to find ourselves taking. It's a path that does not require legislation, political action committees, tax incentives (or disincentives), a majority vote of the entire population, or bloodshed. It merely requires that a critical mass of Americans begin acting in their own enlightened self-interest and that a cohort of doctors and entrepreneurs find ways of enabling them to do so.

For more on what we can do both to protect ourselves as individuals within the dysfunctional American healthcare system, and how we can help catalyze a reformation in healthcare, read on.