A Call to Be Whole: The Fundamentals of Health Care Reform

The problems of today can't be solved with the same thinking that cre-
ated them.

Albert Einstein

Why are health care's problems so intractable? For decades, policy makers and power brokers have tampered with the structure of health care— changing access here, modifying reimbursement schemes there, applying new layers of bureaucracy everywhere. Despite their best analytical thinking, the fixes tend to make things worse. Costs continue to rise; quality and access continue to deteriorate.

We have the most expensive health care system in the world, but it ranks thirty-seventh worldwide in keeping people healthy, and 43 million Americans are without health insurance. We don't see these three facts as interrelated. Even when the problems with the health care system affect us personally—such as when breast cancer bankrupts our sister's family, or our retired neighbor has to seek part-time work to cover the cost of his prescription drugs, or our HMO refuses to pay for ER care because our chest pain turned out to be indigestion instead of a heart attack—we don't recognize these problems as the result of forty years of piecemeal solutions. Incremental or piecemeal solutions cannot solve health care's problems. Cost, quality, and access aren't separate problems; fixing any one automatically impacts the other two.

When health care doesn't match our expectations or when the [improvements] make things worse, we cite poor planning or ineffective leadership, or we blame our favorite scapegoat. As a society, Americans tend to intervene where a problem is most noticeably visible rather than address the

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