There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order, this lukewarmness arising partly from fear of their adversaries … and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it.
– Niccolo Machiavelli, The Prince
Mindful that the Senate has yet to vote on the reconciliation package, one cannot deny that we are near the end of the beginning. The work of animating the words on the legislative page and applying them to this country’s fragmented, proprietary, volume driven, risk aversive system must begin.
Can doctors lead? In many ways the medical profession gave up the reins when they allowed HMOs to assure them stable volumes and regular payments. Since then, the business of insurance and the business of medicine have been locked in a battle for the patient’s health care dollar. Insurance likes you when you are healthy, medicine likes you when you are sick. After all, “health insurance” is really sickness & accident insurance.
So while we may have the best medical care in the world, its ability to meet the needs of our sick nation is challenged. Our health status, if measured by the chronic illnesses we’ve compounded by our lifestyles, behaviors, genetics and the environment we’ve built is poor. Two out of three adults are overweight or obese, and carry with that extra weight the concomitant likelihood of heart disease, stroke, diabetes, hypertension & depression to name a few. While the symptoms can be addressed by medicine, addressing the causes is a societal imperative.
As currently organized nether medicine, nor insurance can correct the behaviors that are the leading causes of death in this country: diet, inactive lifestyle, smoking, alcohol & drug consumption. So what to do? Where to start?
Obama-care gives us a blueprint: You are not on your own, we are in this together.
Universal coverage – make available & affordable an essential plan of medical benefits to everyone.
Reorganize the delivery & financing system incentives to reward the outcomes we need: obtaining & maintaining health.
Patient-centered, evidence-based care – Use the art and science of medicine to work with patients to assess and identify health risks; and formulate longitudinal care & treatment plans that are personalized, predictive, preventive & participatory.
Deinstitutionalize medicine – rather than episodic and emergent care, create a regular source of care and the resources to support healthy living within every community.
Make health a societal value, and a priority. – Support public and population health initiatives, understand the unintended consequences of our actions, but act nonetheless.
So, we are all in this together. There is a lot that should be changed. We all wear the mantle of patient or soon to be patient, or patient in waiting. When we aren’t the patient, we are the advocate – the relative, friend, co-worker, caseworker, an assistant that searches for what else can help and how can we get this done in the best way possible for the person who in need. We are the ones who seek medical advice and are thankful it is available. We trust in evidence-based practice, and advocate for “patient determination.” We want to be able to read our records and discuss our care with our doctor, as intelligent and involved patients.
There are two core principles that I consider with health care reform: 1) We need to return our culture to one that embraces health care as a core individual value (like honesty) with responsibility to maintain our health as best we can and 2) We need a medical system that supports medical professionals to provide knowledge based on science and “best advice” with opinions based on professional experience. If we are able to retain these concepts within the reform movement, then we will achieve better health and better care. The business at hand is trying to extricate our health care from the grip of a profit-centered philosophy. A government requirement for health insurance coverage is the least of our problems. I look forward to this work, let me know how I can help.