I'm thrilled to see that President Obama is keeping health care as one of his top action items. This certainly fits with the mood of Americans (80% said the health system needs major change or complete rebuilding in a Commonwealth Fund survey).
Here's to hoping that experts and policy makers around the reform table have a deep enough understanding of the foundation of high performing health systems, and that a broad array of stakeholders around the table includes more than just the usual expensive suits and well heeled lobbyists.
Articles in the press on the health reform focus on shrinking the roles of the uninsured and encouraging the adoption of health information technology - both excellent goals that unfortunately have little if any effect on how health care is delivered.
If we want to build a high performing heath system, we'll follow the lead of other high performing health systems and create a solid foundation of comprehensive primary care. When people get comprehensive primary care, they are more pleased with the care they get, they end up missing less time from work & school, they end up in the hospital less often, don't have to use the emergency room as much, and all at lower cost that what we currently spend. (1)
The problem is that hospitals make money when their beds are filled. Emergency rooms make money when they take care of people. Doing right for the American people means hurting the income of hospitals. With comprehensive primary care some doctors will be performing fewer procedures, some labs and imaging departments will do fewer scans, some surgeons will do fewer operations.
We must face the painful truth that continued support of a broken system is wrong, even at the risk of hurting the income of some good people and institutions. It is time to step up to plate and change the way health care is delivered.
We will see powerful opposition to real reform and we must stand strong for the reform in the face of that opposition. Because the beltway is so over-populated by moneyed interests, here's to hoping that President Obama's team chooses some outside-the-beltway experts who understand comprehensive primary care, people who put America above moneyed interest.
L. Gordon Moore MD
(1) Wasson, J. H., Johnson, D. J., Benjamin, R., Phillips, J., & MacKenzie, T. A. Patients report positive impacts of collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 199–206.
Comments