from both parties argued strongly for sweeping health-care reform. They didn’t
just argue to insure more Americans. They said, “Many parts of our health-care
system are broken, and we need to fix them.” But when it got ugly, as it sometimes
can get in politics, their focus got more and more narrow. And in the end,
the only thing that could squeak through legislatively isn’t a health-care reform
bill; it’s an insurance-expansion bill. Not much more than that, quite honestly.
It doesn’t really fix the parts of the health-care system that don’t work. It does
very little to increase the health-care workforce, which was the reason for your
founding….
So, we’ve got the culture we built up under Flexner. We’ve got the limits of
the health-care bill…. And there’s a third thing. Did any of you ever imagine
we’d be in the economic situation we’re in? As a baby boomer, I didn’t live in the
Depression, but my parents sure talked about it. And I am constantly struck to
hear conversations today that seem a lot like those conversations they had, about
the way it felt in the Depression, about really wondering if there was going to be
future economic security…. The problems of our health-care system, including
what we spend on health care, lie smack-dab in the middle of our economic situation.
We all hear constantly, on a daily basis, about the threat of the national
debt. Everybody running for office now talks about it on the federal level as a
real problem. What is the biggest single driver of the growing national debt?
Medicare spending. Medicare’s a good idea. Medicare’s a critical idea. But we are
driving it to the limits of unaffordability. And then for those of you in state government,
… what is the biggest driver of problems for state budgets right now?
Medicaid. What is the biggest reason American businesses seem to have such a
struggle being competitive? Health-insurance costs. We’ve loaded them with the
issues of employee health insurance in a way many other nations haven’t, and it’s
breaking their competitiveness globally….
Who is going to fix this? Who can take on all those things at once? …
Somewhere you need to have some of the best minds in the nation who understand
how you deliver health care, how you educate health professionals and how
you study – do research on what works and doesn’t. You need to have those come
together, and they come together in academic medicine.
You’ve started this kind of journey with what you’ve done here. There are three
kinds of change. You have revolutions…. [There’s] the other end of the spectrum of
change, which is incrementalism…. You’ve shown the middle kind of change. It’s
transformational change. It’s where you say, “There’s a lot of good here. We don’t
want to sweep away the old order” – but where you have the courage to admit that
the old order isn’t going to meet our future needs, and you make big change. You
sometimes do it in the face of skepticism from a lot of people around you. Sometimes
you may get tortured by an accrediting body. But you persevere because you believe
the time has come for transformational change. This is what we need in America’s
medical schools, teaching hospitals, in our health system as a whole.
64 | Breaking the Mold