In my ritual of year-end reflection, I am struck by an unshakeable parallel between the general healthcare climate today, and the atmosphere surrounding the late stages of the American Revolution and the start of our fledgling nation. I’ve found myself returning to this construct as a way to organize my efforts in alignment with a sincere desire to bring about lasting improvements in the way we care for each other and promote health in our country.
I do not intend to trivialize the events and complexity of our nation’s birth, nor do I seek to elevate healthcare to an unmerited ideological loftiness. My words will reveal that at my core, I am a patriot. I served in the U.S. Navy and feel forever connected to protecting the key elements of our constitution. Many of those guiding principles were important to forming my personal mission to bring about effective, accessible care and improved health for all people. My transition away from day-to-day clinical practice toward addressing systematic enhancement of healthcare delivery was prompted by an atmosphere of disruption that I see as akin to what occurred in the late 18th century. Then, like now, there existed a pervasive air of opportunity, challenge, and responsibility that seldom occurs in a lifetime. The thoughts, experiences, and work of John Adams illustrate all of these elements well.
I will not pretend to offer any significant authority or academic rigor on historical elements, but it is safe to say there have been few times in history when a nation had such a great opportunity to define its own destiny. Having seen democratic and republican principles in the context of monarchies and being protected by vast geographical isolation and a wealth of natural resources, the United States was blessed at its start. John Adams was impassioned by this previously unimaginable opportunity to create from scratch an ideal system of government based on values in service of the people.
While we are certainly far down a road of trials, failures, and entrenched complexity in healthcare, there is a disruption at hand that affords us a similar opportunity. There is tremendous wisdom present based on worldwide ventures in everything between pure cash-based fee-for-service and the socialist model of universal healthcare. Regardless of where people may stand on the optimal business model for U.S. healthcare delivery, there are values emerging that most are aligned on. These values could form the basis of a new ideal for which to strive. Promoting health is ultimately more important than healthcare delivery, and requires an approach that traditional healthcare is woefully unequipped for. Care delivery should focus on optimizing value and outcomes, and be reimbursed accordingly. People should be better equipped to make decisions that empower them. This is not possible without transparency, and meaningful data portability and communication between current silos of systems and entities. In a modern society, there should be financial protections that protect people in the event of unanticipated catastrophes.
Opportunity and challenge are often perceived interchangeably. Here again, John Adams was both prescient and forceful. Adams was frustrated by how easy it was for people to dismantle what they disdained, yet were then reluctant to engage in the difficult work of building anew. For all the idealism that shaped his daily life, Adams recognized the vital importance of delivering on the tedious work of construction.
One could argue that constructing something new and improved is even more challenging in today’s healthcare environment than what our founders faced in creating a nation. We are awash in political bickering, business competition, value-chain misalignment, social crises, and the inability to wipe the slate clean and start over. But if government, business, and community leaders can insist upon a values-driven common ground, then there is a fragile but vital scaffold to build from. Now more than ever, we need a principle-driven approach to policy while resisting the urge to create specific language and guidelines around every possibility or scenario. Policies should set a high bar around value creation, transparency, security, and interoperability while leaving flexibility for innovative approaches to achieve those goals. This can only be successful with powerful and swift enforcement that incentivizes those embodying the spirit of the policies, and punishes those who do not. I would argue that we have become a frustratingly literal society. We have spent far too much time creating labyrinthine healthcare policies without clearly articulating core values and creating powerful enforcement capabilities.
Finally, I return to what underlies all of this opportunity and challenge, and that is service. As the son of a career Navy officer and then as an officer myself, much of my life was spent within essentially a socialist healthcare system. Money never entered into any care discussion, either as a patient or physician. My abrupt transition to the real world revealed the vast complexities and economic realities of healthcare delivery in the U.S., and inspired me to serve healthcare broadly and therefore all of society. There is so much opportunity for improving access and quality. We can create a system where everyone can maintain more optimal health and never doubt their ability to get effective care. This will require a widespread service mentality similar to what our first elected officials had; a return to the belief that holding office is a responsibility and obligation, not a career destination. All of us can bring this to bear every day. There has never been a greater need for collaboration in the spirit of common values and a greater good. This cannot be dismissed as mere sentimentality. There is real work to be done. We likely will not see another chance like this in our lifetime.