Health reform. Heard enough about it? I sure have.
Not sure about you, but what worries me is the dizzying array of policies, politics and propaganda and as much as I hope we will see our way through this, I find it impossible sometimes to imagine that the possibilities for improved health care – and improved health – will emerge from the current climate.
We’ve been reforming healthy systems for 4,000 years; you’d think we could ‘get it right’ by now, eh? Perhaps bringing some simplicity to the complexity will help: in the form of health reform’s history.-
- First, records left by early civilizations indicate that health systems were created by the king and the employer. Each knew that a healthy workforce was a productive workforce, providing gold for the king’s coffers via taxes and products for the marketplace.
- Second, the earliest written records demonstrate that health care systems were regulated by the king. The first written law – the Code of Hammurabi dating to 1800 BCE1 – contained access provisions requiring care for all, even ordering slave owners to provide health care for their slaves. It also contained price controls for physicians to follow, setting differential prices in sliding fee-schedules for different classes of people – the wealthy, tradesmen and slaves.
- Third, as health systems evolved, quality issues arose. The emperor’s ancient Rome, for example, took over warehousing medicinals when product tainting was suspected and the Oath of Hippocrates2 created early peer review and process improvement mechanisms.
- Fourth, access, quality and cost, have always been the ‘big three’ of health reform. As access improved, costs increased. As price controls were created, quality suffered. As quality improved…well, you get it. Over time, we’re learned to meet one or two of our ‘big three’ goals, only to see the others careen out of control.
- Fifth, what is new is that for the first time, we’re trying to solve for all three simultaneously.
Can we do it? So far, no government has succeeded. No criticism of the current Administration intended, but this is a ‘very heavy lift’ and house parties aren’t going to help advance a cause this complex if all they do is focus on problems and not also address solutions – like personal responsibilities that each person can take now.
Sorry to beat the drum but have you protected yourself, your family, your workplace and your community with influenza immunization yet?
Especially if you’re inside the Beltway, your local public health experts are warning that flu is on the way3 and there is plenty of injectable and nasal spray left!
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- Are providers responsible?