Health Care Reform for U.S. Posterity

A Successful and Sustainable Health System — How to Get There from Here, by Harvey V. Fineberg, M.D., Ph.D.,N Engl J Med 2012; 366:1020-1027,  March 15, 2012

(Link: http://www.nejm.org/doi/full/10.1056/NEJMsa1114777?query=TOC&utm_source=Twitter&utm_medium=Tweet&utm_campaign=Hootsuite)

A colleague and friend of mine recently sent this thoughtful article by Dr. Fineberg at IOM.  In a nutshell, he recommends supporting the efforts of ACA but also:

• Redouble efforts to enhance quality and safety of medical care
• Focus on health needs of patients who require high cost care to reduce hospital admissions
• Honor patients' preferences regarding late-stage illness, allowing those who want it to spend more quality time with loved ones in more familiar and comfortable surroundings
• Rely on systems engineering and operations research to smooth the flow of patients through the health care system
• Participate in data gathering and performance comparisons regarding pertinent aspects of patient care so more widespread adoption of simple, advantageous advances in care
• Adopt new ethos of medical professionalism that values accountability above autonomy; supports team-based care, and inter-professional education, and accepts responsibility for a system to serve all patients, not only one's own patients

He concludes that we need to do many things at once to reduce inefficiency (compared to other industrialized European countries), supporting prevention, championing competition, comparing effectiveness, removing commercial influences on medical decisions, changing the way we pay doctors, and re-engineering the system - all these changes and more...

With March Madness all around us, I am reminded of the difference between a basketball team and other sports teams - five team members all doing different things, but together focused on one goal 80 or 100 times during the 60 minutes of play time: and doing it all at once.  Health care reform is really about the ingenuity of the American people working together for prosperity.....