· Government agencies In all the fieldwork I’ve done in dozens of U.S. hospitals and clinics, I see doctors and nurses so beaten down by the daily drudge of bureaucratic regulation (by the feds, by the state, by their employer, by what the health plan will cover, by best practices, by their malpractice insurance carrier) that they feel they can no longer exercise their professional judgment. And they have often lost the passion for what made them go into medicine in the first place. We need to de-regulate the daily lives of clinicians and create policies and frameworks that let them do their jobs with flexibility and trust. Personal Health requires that kind of flexibility—it demands mass customization of care—that government has to foster through reform policies that focus on care flexibility, personal health, and continuous improvement.
· Doctors are going to have to return to—and be paid for delivering—integrated, coordinated, personalized care for the holistic needs of their patients. It shows just how troubled our specialty-care system has become that we’ve had to launch a “medical home movement” to push for doctors to return to basic communication and coordination behaviors that ought to be a core part of every physician’s motivation, education, and reward in the first place. We’re trying to get back to the basics of primary care that we should have never left in the first place, and that kind of culture change will require patience, persistence, and new incentives for care coordination.
· All of us are going to have to take a more proactive role in managing our illness, injury, and/or recovery, which means educating ourselves about treatment options, costs, tradeoffs, and behavior changes that get us back to good health. We’re living in this fast-food, high-stress culture but have to find ways to eat better and exercise more, period. You’d think living a higher quality, longer life would be enough incentive, but we’re going to have to explore more controversial ideas like premium discounts or tax breaks for healthy behavior (which means higher premiums and/or taxes for unhealthy behaviors). I’m sure we’ll hear cries of a “nanny state,” but better some carrot-and-stick incentives for changing our culture than to bankrupt ourselves or perpetuate millions of Americans being left with no healthcare access at all.
I hope President Obama will use his Wednesday night press conference this week to start to address some of these culture change issues…that he’ll paint a picture of the new social contract we’re going to have to sign up for in healthcare reform if we want quality, affordable healthcare for all.
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