Upstream from the health care reform debate

As I read about and watch the machinations of the legislative process, public commentary, corporate pushback on health care reform, I keep scratching my head and ask, “What is missing in this discussion?”

In my view, the conversation needs to change from “How do we pay for expanded and universal care?” to “What kind of care and health outcomes are we really looking for?” Like moving deck chairs around on the Titanic, focusing on how to reallocate resources in health care without looking at the causes of those costs is short sighted and potentially fatal. Upstream from the current debate are important foundational issues. If these remain unaddressed, it will result in failure of any attempts to reform our health care system.

These issues are:

  1. The important role of a societal commitment to health promotion, prevention, and lifestyle change.
  2. Health workforce reform to provide more primary care providers into the system.
  3. A renewal of our commitment to principles of integrative medicine including patient centered, low tech, high touch care, natural remedies, and acknowledgement of the body’s ability to heal itself.

I recently read and recommend to you an excellent, visionary book by Dr. Andrew Weil, Why Our Health Matters: A Vision of Medicine That Can Transform Our Future (New York: Hudson Street Press, 2009). I concurred with many of the points made in this thoughtful and provocative work. Politically and socially we have our eyes on the wrong ball in the current debate. Rather than trying to figure out how to finance and prop up a health care system that is ranked only 37th in the world but is at least twice as expensive as any other country, we need to change the questions we are asking. If we are on the par with Serbia in terms of outcomes, failing to provide care to many of our citizens, and at the same time seeing enormous profits made by health technology, pharmaceutical, and insurance firms, isn’t there something wrong with the picture? And how about the prospect of generating an enormous federal deficit to be paid for by our future generations to support a system that isn’t working well anyway?

Weil looks the problem as rooted in several myths we seem to hold about our health care system: