Fixing Healthcare in the United States: a 10 Point Agenda

July 2003

The healthcare system in the United States can be, and should be, much better than it is now. Rather than tearing it apart and starting from scratch, this essay takes the view that incremental changes, developed honestly, are the only feasible way to get from where we are to where we want to be. Otherwise, the political pain is just too great, and nothing can move forward. To be realistic, improvements to our nation's healthcare plan must be based on simple concepts that are concisely expressed and easily understood. A plan based on ten conceptual points is proposed. These points are structured so that with adequate leadership, the impetus for change can be developed using the existing legislative and regulatory infrastructure of the federal and state governments. Additional clout will be provided by the various public interest organizations and healthcare accreditation organizations. Free-market economics will then provide the economic fuel required to implement these changes. To make the case that such an approach can work, several illustrative examples are provided. The ten concepts that will serve as the building blocks for change are:

1. Accept reality
2. Be honest
3. Build a system that can respond to change
4. Pool risk, so that individuals and small organizations can truly experience the benefits of group insurance
5. Address the problem, not the symptom
6. Strive for excellence, not profit
7. Improve the quality of education of medical professionals
8. Develop appropriate metrics for assessing what works and what doesn't
9. Embrace technology
10. Ensure accountability and stability through the use of feedback and oversight mechanisms between all players in the healthcare system.

These points are discussed in turn. The essay concludes with a discussion of what a healthcare system inspired by these concepts will look like.

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