Welcome to On Our Minds, the latest feature from the Farley Health Policy Center, where we will share commentary on policies affecting health, trends from findings in data and research, and the issues that matter most in our communities. We invite you to share your perspectives and input. Drawing on expertise from our evolving network, we’re eager to work with you, learn from you, build and share policy commentary that brings us together and continues to move us forward.
Mark Gritz, PhD
Larry Green, MD
We have been reviewing Dr. Don Berwick’s recent article in JAMA and it revived a discussion we have had off and on regarding the current state and future of the U.S. health care system. We think it is safe to say that one of the few areas where there is broad consensus is that the US health care system is broken and dysfunctional, creating both inefficiencies and inequities for our society that are frustrating, infuriating, and (at least to us) unacceptable. Dr. Berwick points out a few examples of these inefficiencies and inequities, but he proposes actions that may matter but seem to assume our current health care system can be fixed. Our current quagmire has resulted from tweaking it around the edges over and over and expecting a different result. Instead, we believe that a major overhaul is necessary.
To make any significant improvements in the efficiency and equity of the US health care system a paradigm change is needed. Borrowing from Thomas Kuhn’s The Structure of Scientific Revolutions, we have been stuck in phase three. During phase three, the inability of the current paradigm to address the obvious anomalies in the system are widely recognized. We should have progressed to the paradigm shift in phase four years ago. What is preventing us from working together to make the major changes needed to effectuate a paradigm shift?
We postulate that our politics are adamantly opposed to a paradigm change. Many interests benefit greatly from the dysfunctional situation we are in and aggressively resist changing it. The fundamental political barrier to a paradigm shift was possibly best expressed by Thomas Sowell: “The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics.”The financing and delivery mechanisms that sustain the current mess must change to enable improved efficiencies and relieve inequities. Another significant barrier that firmly took hold about 30 years ago is the extremely partisan politics that has quashed the healthy exchange of ideas and the objective examination of evidence to inform the needed paradigm shift.
If you are as frustrated and enraged as we are, please join us in a healthy exchange of ideas by sharing your insights and vision for a new U.S. health care paradigm. To kick-start the exchange of ideas we submit two well-recognized alternative health care financing and delivery paradigms: (1) a single-payer national health service, which is often referred to as the Beveridge model; and (2) a market-based health care system with patients and providers directly engaging in health care transactions, which is often mischaracterized as the out-of-pocket model. These are just two of many possible new paradigms to replace what is currently a broken system.
The Farley Health Policy Center welcomes the healthy exchange of ideas and will curate and post your best thinking to our website. E-mail Alison Reidmohr at firstname.lastname@example.org or tag us on Twitter @FarleyHealthPol.