The View from the Lake

The fourth of July is one of my favorite times to take off from work. I'm blogging this week while taking a break from my day job.

What are we doing well in health care in this country? I'm on vacation, staying with my brother, Joe, and his family, on beautiful Lake Norman in Mooresville, N.C. I put the question first to him. We were sailing his comfortable, old MC-16 racing scow at the time. Like me, Joe is a family physician. Our career paths couldn't have been more divergent, however. You see, Joe is a country doctor serving the good folks in rural Cooloomee, N.C., employed by a health-care system. Given that we're both FP's, we often enjoy many engaging debates about health care and where it's headed. The cynic in Joe responded immediately, "We do a great job of working within whatever reimbursement rules they set up to maximize our take-home pay." After gently chiding him that that response was not in keeping with the spirit of this week's question, I did have to agree with him, paraphrasing Don Berwick and others who have made the point countless times that, "Every system is perfectly designed to produce the results it produces."

After enjoying a good laugh, we settled down to serious consideration of the question before us and quickly came to the same conclusion: whatever flaws inherent in the U.S. non-system of health-care, we continue to do a terrific job of innovating, especially in the area of clinical technology. Minimally-invasive approaches to fixing surgical problems came immediately to mind, such as stenting of otherwise inoperable vascular lesions or robotic-assisted surgery. But as family physicians, we both see first-hand the incredible disparities in access to these marvelous technologies that the current non-system fosters. Even more glaring is the uneven access to basic primary care. But for all its flaws, the U.S. health-care industry has, within its DNA, an innovation engine that is second to none. When fully engaged, meaning when financial incentives are fully aligned, this innovation engine will, I believe, be able to fix the problems of primary care access and financing disparities that are at the heart of the health-care maelstrom we find ourselves in.

The way to ensure that we continue to be the world's leading clinical innovator is to take comparative effectiveness research seriously and continue to seek out and fund high-value therapies. Surprisingly, very often the highest-value therapies are the newest ones, delivered in innovative ways in so-called Centers of Excellence. But most often it's just good old-fashioned primary care that really delivers the most value for the health-care buck. The trick, as we've discovered at Quad/Graphics, is to strike the correct balance between the two.

By Raymond J. Zastrow  |  July 3, 2009; 12:43 PM ET  | Category:  Health Care Reform
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Posted by: lensch | July 6, 2009 3:36 PM
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