There is no question that the health care system(s) in the US is in need of repair; there is no shortage of the number of well documented, significant problems and challenges. But there is another side to US health care: that is, those elements that are working. What would you caution a new President and Congress to preserve, to encourage, to replicate?

The blog posts below explore this topic:

• A Dynamic and Diverse Pipeline
• Health Care Reform & the the Average “Joe”
• Replicating Innovation, Dissolving Boundaries
• Preserving What Works in Healthcare
• Preserving a Diverse Health Workforce
• A Nation of Innovative Problem Solvers
• Performance Metrics: Counting What Counts

It was like nothing had changed since I left my dorm room in Escondido Village in 1998. It was the same academics muttering about “access, affordability, and quality.” And it dribbled on…“rising healthcare expenditures, cost containment, rationing resources,” …blah, blah, blah. This is why I loved it when Mark Smith, M.D., CEO and President of the California Healthcare Foundation, took the stage and opened his talk with the slightly irreverent comment. He said, “Here we all are talking about healthcare reform, and not one of you has mentioned the patient yet.” I wanted to stand up and applaud (and in full disclosure Mark serves on the Google Health Advisory Council).

I do not pretend to have the magic bullet for healthcare reform in the U.S but here is what I do know about the average “Joe” on the street and what I have learned working on the Google Health team for the past 2 years.

When it comes to healthcare, we are all in denial!

• No one cares about their health until they or a family member gets sick.
• The average consumer (over 52% surveyed) does not understand their health insurance benefits. (Deloitte Center for Health Solutions, 2008 Survey of Healthcare Consumers).

The Un(der)insured are no longer an abstract term. We know them, we are them.

• If 1 in 4 Americans are insured but not adequately covered (Consumer Reports), you most likely know them. These people are your friends or ex-colleagues who have left big companies to go out on their own as sole proprietors and are forgoing comprehensive health insurance until their business takes off. It’s your neighbor who recently got laid off and could not afford his COBRA extension.

People Are Online and Getting Information from Non-Experts – So Deal With It!

• People are hungry for information and want to hear from other patients like them.
• I mean think about it, everyday 8 million Americans research a health related topic on the internet, 66% (>5 million) start with a search engine (Pew Study, October, 2006). Roughly 65% of internet users use the web as their primary source for researching health issues and about 87% of all U.S .physicians use the internet on a daily basis. (Harris Interactive/Google Study, Assessing the Impact of Online Behavior on Healthcare Decisions, May 2007, not published online)
• More than 20% of American internet users have created some sort of user-generated health-related content – like an online community about a certain condition (Jupiter Research, February 2007).
• Roughly 10 hours of video gets uploaded to YouTube every minute, so you can imagine how much is getting loaded on health related experiences or personal health diaries. Just go and search on it today.

People are Spending A lot of Money to Stay Beautiful and Young

• People seem to be willing to spend a lot of money on maintaining their looks, beauty, and wellness.
• There were 11 million plus plastic surgeries performed in 2007 (American Society of Plastic Surgeons) and surveys show that more than half of the U.S. adult population use vitamins, herbs and other forms of nutraceuticals (FDA).

These are just some interesting consumer trends that I think about every night as I commute home from Google. Google Health is our first foray into the area of consumer health. We have just gotten started and we have a lot more to do and learn. But if there is one thing I learned this week, healthcare reform enthusiasts should take a hard look at what consumers are already doing today. We could all learn from how we are currently activated and NOT activated in our own healthcare rather then recycle old debates on access, quality and costs.

The views expressed in this blog post are mine alone and not those of my employer.

I struggle to name something to preserve. I don’t even like the word – it speaks to me of mothballs and museums. Or perhaps that is what we should intend, let’s put the antiquated systems, the major gaps and disconnects, the huge disparities and inequities in mothballs. Let’s preserve them in a museum, to remind ourselves of what a mess we made of it. And let’s disconnect them from the whole, so they cannot damage it any further.

I heartily encourage innovation in healthcare that takes advantage of strong social trends: the Long Tail, social networking, the generosity of information sharing in programs from large to small. We have examples in the Human Genome Project and Facebook Causes. I encourage the most imaginative and disruptive of the current systems to grow in influence, and for us to provide systems around them so they can flourish. Some of these systems are on the ground, in the new space created by imaginative solutions. They are affinity groups, community-based organizations, and consumer-directed projects.

This leads me to what we should replicate. We should replicate the successes, but not without a critical eye to the future. Looming before us are not only dysfunctional systems, but also vast amounts of information, new technologies, and phenomenally creative minds. The systems, programs, and projects that are working need to be proactively attentive to the future, and need not to fall into the trap of complacency, competition, and territorialism. We need to replicate the disruptive innovation that has been a hallmark of good work in the world since the beginning of time. We must look for leadership that has blown open the doors and transformed systems; and replicate not their work, but their ability to identify places where potential energy is waiting to be transformed into kinetic energy.

I say to the new President and Congress: your task is not to play the hero leader, but instead to discover how to unleash the full potential of the people – from the community leaders, to the heads of companies and agencies – by keeping your eyes on the prize in all cases, and witnessing to the deepest truths. Dissolve boundaries, and we will all be freer to lead.

Leaders have a particular burden, and all too often it is mistaken to be one of power and perfection. It is about authenticity, about community, and about compassion. That, with decisive action, measured against the ultimate goals, will transform health.

The private market will continue to have a role as well. Our pharmaceutical and biotech industries are responsible for major advances in finding pharmaceuticals to address both cutting-edge needs and rare diseases. Our medical technology industry has developed less intrusive procedures and technological solutions to enormous medical problems. As we seek to eliminate waste and inappropriate care, and as we address the challenges our health system faces, primarily to cover all Americans, improve the quality of care and control costs, we must do so in ways that don’t slow advances in medicine.

Finally, recent government and private sector initiatives to foster public-private collaboration on such issues as information technology, chronic care management, payment reform, access, accountability and patient safety – while they might benefit from careful review – were begun to explore the value of innovative approaches to solving problems and should be retained as we move forward. A fascinating example of such innovations is comparative effectiveness research, on which there is still debate over the most effective and appropriate governance. Consensus must be reached on how to build on the work of AHRQ and others in this critical area of advancing our knowledge about what works and what doesn’t work, so we can target our spending appropriately.

The answer is that we are a nation of innovative problem solvers, and we have brought that skill to health care. So even in the face of the seemingly intractable problems created by our health care system, problems are solved every day, and solved well. There are many examples – ones that will show up on this blog no doubt – of employers, which continue to cover over 170 million people in this country, successfully implementing changes in benefit design that both improve care and lower costs; of introduction and adoption of new technologies that improve care and decrease costs; of doctors and health care institutions who move beyond the challenges inherent in the fee-for-service environment to provide excellent and efficient care; of systems developed to provide people with full and complete information on cost and quality.

As a provider of technology we see it everyday. We see it in the AT&T Labs where we are working to develop ZigBee networks – named for the zigzagging path data takes to reach its destination like that of a bee zigzagging from flower to flower – to weave together data from short range, low power wireless devices to make independent living a reality. We see it in innovative applications of surprisingly simple technology such as one being developed by our technology partner, Confidant, which uses a teenager’s cellphone to track and improve treatment for Type 1 diabetes. This application wirelessly sends blood sugar readings these teenagers must take multiple times a day to the doctor’s office via a Bluetooth enabled cell phone with a touch of a button. Text message reminders are sent if a reading is missed and encouraging messages sent if readings are regular.

We also see it in the progress that has been made in both the private and public sectors on introducing a continuous stream of new technology based products and developing the standards for interoperability, security and privacy that are necessary for the full scale adoption of information technology in the health sector. And we see it in the resources technology companies like AT&T, with their expansive expertise in building networks, managing information and harnessing the power of computing, have dedicated to development of the necessary standards and products.

We need to encourage this kind of innovative problem-solving in all aspects of the financing and delivery system. We need to recognize that the ability of any and all stakeholders in the ecosystem to develop and implement new ways of doing things will be central to the success of any effort at reform.

Reluctantly, I am going to use a war metaphor to amplify. The national discussion on wars often emphasizes the “troops on the ground” and their perceptions of their situation. I try to imagine all those soldiers being asked to divert themselves from their primary responsibilities to collect “performance metrics” so we can find out where they are failing to do their job or making errors. I picture us posting these shortcomings so we can prove that we are transparent. I try to imagine literally hundreds of external experts creating elaborate documents and initiatives designed to ignore the larger enterprise of war and instead creating bureaucratic monsters eating time, resources and even lives in an effort to tinker with the system. I try to imagine soldiers incessantly being blamed in the media for the obvious human errors that wars create. I try to imagine benchmarking this war against other wars so we can see which war is more wonderful. Enough!

I like to think that my analogy is germane because the two groups share a common goal: keeping Americans safe.

In the next cycle of change, I would hope we might get back to the overriding mission in health care: to take care of people faced with challenging health experiences. Quality care and cost containment are polar forces to be balanced. Using the tools of cost containment to assess quality care is at best naïve. Try measuring compassion or the tears of a child watching her mother die of cancer. “Not everything that can be counted counts and not everything that counts can be counted.” (A. Einstein) A bit more emphasis on the mission might change the dialog.

I would recommend the President, his cabinet members, and all the members of Congress try an anonymous three-day hospitalization. They could go through the admissions process stating they have no health care coverage, for starters. The “boots on the ground” might inform the discourse, unveil the impact of provider shortages, demonstrate the nuanced nature of giving good individualized health care, reveal the cost of cost control measures, and introduce them to some providers who are trying to give quality care despite all the disturbances swirling around them.