Down the Rabbit Hole: A New Model of a National Health System, Part 1

Healthcare is a hot agenda item with the new Obama administration. That's how it should be. With the costs associated with care and the millions of Americans either un or under insured it needs to be fixed. Recently Mr Obama announced a plan to ensure the the universal application of electronic health records in this country as part of his package of reforms. And with that bit of sagely advise that he got from the Harvard folks I have begun to get serious gastrointestinal upset. I'm seeing early warning signs that the Obama proposals are going to be a rehash of what's come before. And trying to prevent this is that to which I have dedicated the last 20 years of my career. The science of healthcare delivery systems is what I study and how I make my living such as it is. It is my passion and my mission.

Many of the people with whom I work would have a cow if they knew I was about to launch into a conversation on this particular topic. My academic and industry work in the area is required to be more accommodating and diplomatic. There are always lots of feathers to sooth and endless meetings with 'stakeholders' and opportunities to create 'buy in' and a thousand other administrative platitudes that result in the appearance of progress in meeting minutes. Then there are the business interests that have a lot to gain or lose depending upon how the political wind sock is pointing. Lastly clinicians, patient advocacy groups payers, governmental agents, academicians, you name it point fingers to all the others as the source of the healthcare meltdown. Few are willing to admit that all have a hand in the problem and all will have to sacrifice something to fix it.

But here it's different. This nom de plume and blog site offers an opportunity to express the more controversial aspects of what this research suggests we should and can build. I'm a medical systems heretic and I love what I'm doing.

My previous post have largely been personal opinions experiences and thought experiments but on this particular topic I'm actually somewhat of an expert. Over the next few weeks and months I'm going to discuss key aspects of a sustainable and logical plan to create a National Health System. A System that could be the envy of the world. And we'll talk about why this electronic health record proposal could kill it before it's born. You see, I believe with all my heart that it's time for a National Healthcare System for the US. But not one like most people imagine... Anyone interested in seeing what's down this particular rabbit hole? I'll give you the first clue - it's not a single payer system. In part 2, I'll share with you what's wrong with that old single payer model.