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Editor’s Notes: What Do the Memoirs of an Eighteenth-Century French Noblewoman Have To Do with Readmissions Reduction?

October 1, 2015
by Mark Hagland
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I’ve been reading, and thoroughly enjoying, Dancing to the Precipice: The Life of Lucie de la Tour du Pin, Eyewitness to an Era. The 2009 biography by British historian Caroline Moorehead recounts the life of a woman named Lucie-Henriette Dillon, who became Marquise de la Tour du Pin, and was in fact eyewitness to an incredible period of history, from the last, naïve days of the court of Louis XVI at Versailles, to the entirety of the French Revolution, and all the way through the Napoleonic era and up to the Revolution of 1848. Living from 1770 to 1853, Lucie Dillon witnessed, and survived, an astonishing number of revolutions, upheavals, and transformations of society.

As Moorehead notes in the last two pages of her book, “The France into which Lucie was born, in the spring of 1770, was no more. Versailles had become a museum. Steam, the telegraph, trains, gas lighting, the smokestacks of industry had between them transformed the landscape of her childhood into a world she would no longer recognize.” What made it worth writing a biography of the Marquise was the fact that she had written long diaries describing her life from her birth in 1770 through to 1814, and, in 1907, 54 years after her death, the Marquise’s great-grandson published her memoirs as a book. That book of memoirs, which has rarely been out of print since then, has provided countless readers with a personalized window on those very dramatic times in France and in Europe.

I read the Marquise’s memoirs several years ago, and found Moorehead’s book even more enlightening. It is fascinating to get her completely unvarnished first-hand perceptions of historical figures like Louis XVI, Marie Antoinette, the Marquis de Lafayette, and Napoleon. Even more fascinating are Lucie’s accounts of the waning days of Louis XVI’s court at Versailles, a court so decadent and detached from the life of the people of France that its excesses helped to fuel the French Revolution.

What’s especially fascinating is how, even after the fall of the Bastille, many French nobles and royals were blind to the emerging Revolution, and tried to carry on as if nothing had happened. Instead, Louis XVI and Marie Antoinette spent the next few years dithering and prevaricating on needed reforms, until their kingdom collapsed, and they lost their heads on the guillotine.

Now, don’t worry—I’m not predicting that any U.S. healthcare leaders are going to lose their heads! But as I wrote in a blog in late August, it has been rather astonishing to me how the readmissions reduction program under Medicare has been unfolding of late, with a Kaiser Health News analysis published in early August finding that more than half of U.S. hospitals are being penalized for avoidable readmissions, in the fourth successive year of that mandatory program. Is that program a challenging one for hospitals? No doubt. But the reality is that the Affordable Care Act was passed in March 2010, and for a few years before that, there were strong hints that readmissions reduction might become mandatory under Medicare. What’s more, private insurers inevitably have gotten into the game, too.

So the rather slow response of so many hospital leaders to the federal mandate around readmissions reduction strikes me as another example of the healthcare industry’s generally slow-ish response to rapid changes in the policy and reimbursement landscape. Yes, readmissions work is challenging and difficult. But really, the times are changing rapidly. Take it from a marquise who saw the end of the Ancien Régime: once things start changing, change overtakes stasis very quickly indeed.