This piece is beautifully written by Dr. Donald Berwick, a former CMS administrator and one of the foremost voices in healthcare reform and quality. Here is a quote from the beginning.
“In the mosaic floor of the opulent atrium of a house excavated at Pompeii is a slogan ironic for being buried under 16 feet of volcanic ash: Salve Lucrum, it reads, “Hail, Profit.” That mosaic would be a fitting decoration today in many of health care’s atria.
The grip of financial self-interest in US health care is becoming a stranglehold, with dangerous and pervasive consequences. No sector of US health care is immune from the immoderate pursuit of profit, neither drug companies, nor insurers, nor hospitals, nor investors, nor physician practices.”
If you care about healthcare in this country at all, you owe it to yourself to open the link and read this piece. Americans feel that our institutions don’t serve them and at one time you would often hear “We have the best healthcare in the world.” No longer. The problem of greed is the greatest barrier to improving our healthcare system for every American. Our current system is based on extracting the maximal amount of money, not on science and best practices. We have been here before.
The Flexner report published in 1910, kicked off massive disruptive change in medical organization and practice. Prior to that time, medical school was much like a barber college or a secretarial school. “This is from Abraham Flexner's description of kind of American school that he reported on 100 years ago. ‘The schools, he wrote, were essentially private ventures, money making in spirit and object…” Flexner and his colleagues in the Hopkins Circle drove drastic reform of our medical schools to ground them in science, facts, evidence, and the truth. Now we are drifting away from those core principles.
A National Academy of Medicine book published two decades ago echoes Dr. Berwick’s condemnation of the current system.
“The American health care delivery system is in need of fundamental change. Many patients, doctors, nurses, and health care leaders are concerned that the care delivered is not, essentially, the care we should receive. The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits.” Nothing has changed. Nothing. Michael Millenson completes the picture with his lankmark piece The Silence.
“Despite several well-crafted Institute of Medicine (IOM) reports, there remains within health care a persistent refusal to confront providers’ responsibility for severe quality problems. There is a silence of deed—failing to take corrective actions—and of word—failing to discuss openly the true consequences of that inertia. These silences distort public policy, delay change, and, by leading (albeit inadvertently) to thousands of patient deaths, undermine professionalism. The IOM quality committee, to retain its moral authority, should forgo issuing more reports and instead lead an emergency corrective-action campaign comparable to Flexner’s crusade against charlatan medical schools.” There is no ambiguity here. Flexner’s efforts led to the closing of half the medicals schools in the country. It is time to do something!
Let me make this clear. What I am describing here is not aimed at the many people who actually meet patients face to face and care for them. They are also victims of this system and do the best that they can in spite of it. This is aimed at the leaders and policy makers. I won't leave it at that. The next post will propose solutions
This is no big surprise to observers of healthcare. The big payers and also health systems have seemingly built moats around themselves. Honestly, we know that our investment in healthcare is a poor one with unpredictable outcomes. I’m most interested in the fact that various market forces are challenging the institutional players and many purchasers are embracing data, analytics and a motivated tactical mindset to purchase their services differently. This piece is accurate and depressing. I’m actually more optimistic relative to changes in healthcare than I’ve ever been before. The opportunity for competitive, optimized, warrantied health services in an open market is at hand. The incentive for purchasers to buy this way……is also finally here. We’ll see.