A Vision For Tomorrow’s “Healthcare Nation”

15 05 2007


One of the challenges we face in building public support for changing our healthcare system is a lack of excitement about the topic. It’s a complex, financially-driven area, and even the goal of “insurance for everyone” is essentially a financial platform. So, how do we galvanize support for meaningful change? One way is to focus beyond finance and articulate a global vision for healthcare’s future.

I’ve sketched out some “positive visions” before – first with a two-parter on national security, then with a proposal for a new WPA-like national service organization. Since healthcare’s been my professional area, I thought I’d try drawing a broad outline for a meaningful global redesign of the U.S. system.

Call it the “U.S. Healthcare Nation.” It contains millions of people (doctors, nurses, administrators, technologists, engineers) as full-time participants. Every American is part of it, too, as a “consumer” of medical services. (I’ve never liked that word in the healthcare context, because it implies a level of autonomy and choice that doesn’t exist for most of us.)

If America’s Healthcare Nation were an independent country, it would be the fourth largest in the world as measured by GDP.

Healthcare Nation shares many characteristics with its host country. There is gross maldistribution of wealth. Profitmaking entities sometimes act unchecked, upsetting the balance between public and private interest. Special interests dominate the policymaking process.

There is an enormous amount of creative energy, too – in medical research, technology, entrepreneurship, and social activism. Most of its professionals are dedicated to the healing arts, rather than to self-interest.

There is widespread public support for reform, especially regarding our lack of universal coverage, both among Healthcare Nation’s denizens and within the public at large. But that support is as thin as it is wide. Otherwise, the “Harry and Louise” ads of the 1990’s would not have been so effective in crushing public support for the Clinton health plan (which admittedly had other problems as well.)

Solid popular mandates for change are best won with a broad and positive vision of an alternate future. This has been true throughout American history, whether you personally approve of that change or not: Manifest destiny. A New Deal. The New Frontier. Morning in America. So, what should tomorrow’s “U.S. Healthcare Nation” look like?

For one thing, it should draw on those strengths that are uniquely American. Foremost among these strengths is our American value of fairness to all, which in this case means universal coverage. Lack of insurance kills more people per week than died at Virginia Tech, yet their deaths go essentially unnoticed. As I’ve written before, I believe all Americans should receive Medicare-based coverage with the option to purchase from private plans.

That’s the financing part. What about the rest of the Healthcare Nation? That’s where we can try engaging the interest and enthusiasm of the American people. Sure, we need to catch up with the rest of the industrialized world by solving the problems of uninsurance and underinsurance. But those of us who want universal coverage can go further than that, by articulating a broader vision that integrates the best of our talents and interests.

I’ll describe one positive vision for Healthcare Nation in Part Two to this post. But here are a few characteristics: Digital communications technology will catapult the U.S. from a “wanna-be” to a leader in both the health and communications fields. The imagination and initiative of the Silicon Valley will be set free on curing illness and injury. Doctors and patients will both be provided ‘cognitive partners’ to enhance their decision making processes. And a ‘culture of health’ will replace our present ‘culture of recovery.’

Our national goal will be to make the U. S. healthcare system – Healthcare Nation – the envy of the world in terms of accessibility, effectiveness, communications, and innovation. In the process, we’ll insure everyone. But we’ll provide them with substantially better care. 16% of our economy will flourish. The health sector will generate new ideas and technological breakthroughs that will benefit the entire economy and society as a whole.

These things are possible. What’s more, articulating them may be necessary in order to unite the American people behind a new and positive goal for their ailing healthcare system.




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