Ode to Health Care

Is all lost? Is there anything worth saving? Or is the American health-care system a relic from a time past, a virtual dinosaur in an age of transformative ideas and progressive best practices? Can we literally afford to scrap everything and just start over? If we did, what would we sacrifice and what would we retain: employer-provided health benefits, mandated access to emergent care, individual choice in provider selection or fee-for-service medical reimbursement. All are relevant items in the larger discussion, ranging from the debatable to non-negotiable mainstays. Agreed, interrogating the current model is tedious; however, an honest assessment is crucial in going forward. Reform should be approached through the lens of wellness -- and whatever perpetuates a disease care system (as opposed to health promotion and total well-being) should be discarded.

That said, the glue that binds it all together is the sanctity of the patient-provider relationship. It must be protected, rescued and reawakened in some cases. Choice, whether in choosing a physician or a private or government-backed insurance option, cannot be framed as the adversary of quality or cost-effective care, but as its foundation. As such, patients are empowered to make better health-care decisions and likewise physicians to choose the best indicated treatment plan. Americans and providers are not willing to sacrifice total autonomy, nor should they. On the other hand, autonomy paired with ample choices, and an emphasis on wellness, are part and parcel of a potent policy prescription, and represent a delicious hybrid of old and new without compromising our core values.

So if we keep anything, let us maintain that medicine is a virtuous and noble profession, best predicated on health partnerships. In doing so, medical education must reflect the dual role of healing and advocating better health. As well, the system of health-care delivery must provide incentives for healthy outcomes and erode barriers which have whittled away patient-physician trust and intimacy. Our doctors must not be viewed as strangers, at odds with our private lives, but wise counselors, expert references and an extension of our communities.

Looking back, I recall a guest speaker who had been invited to lecture my medical school class on cultural competency. While the bulk of the topic centered on health care biases and disparities in care (a meaningful and necessary dialogue), she stoked something more fundamental. In calling out an unfortunate truth, not to ascribe some malicious intent, she showcased the importance of sound doctor-patient relationships. Her goal was not to excuse or minimize the role and accountability of others, but to peg the health-care provider as a very valuable commodity and medium on which good care hinged. I highlight this to say let us salvage what is best in American health care, the sacred army of well-trained health-care providers and the patients who have come to rely on them in the battle for good health. Let us build on the basics.

By Chris T. Pernell  |  June 30, 2009; 7:22 AM ET  | Category:  Health Care Reform
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