A much better health care system.

Although some pieces of the new health care law are intended to improve the way the delivery system works, they are fragile, complex, and politically vulnerable. Taken together, they are less than what is needed to reform this complex enterprise. They also vastly overestimate the power of insurance companies over providers. Failing to think more clearly about what is truly broken in our system is a luxury we cannot afford, especially with the impact of the baby boomers looming on the horizon. If we provide care to this group with the same excesses that exist today, the country will be on the road to a truly unprecedented crisis. This crisis will lead to policies that impose severe constraints on the ability of Americans to get the care they need. I won't repeat the tired statistics about how expensive the system is and that its cost is unsustainable. I will mention that more needs to be said about what the nation's governors know all too well: the cost of health care is draining resources from the many other programs that need funding at the state level. These include education, infrastructure, and public aid. The more we spend on health care, the less we have for these programs. Focusing primarily on how to extend coverage--as we have during the most recent debate--may be politically expedient, but it hides the real issues and guarantees an inadequate answer to the nation's health care problems. However, there is another way to think about the problem with the nation's health care system that lays the groundwork for the kind of solution we need. We can think about the delivery system in terms of what we get for what we spend. We can explore the cost, quality, safety, and effectiveness of the care actually provided--revealing how the system truly performs and what it takes to make it better. Flaws in the System Such an analysis exposes some serious problems with the health industry, but also offers some clues about how to address them. Most experts in the field agree that at least 30% of the care that is provided in the current health care system is clinical waste (Institute of Medicine 2000). A big part of that figure is medical services that have no demonstrable benefit for the patients who receive them. Worse still is when these services are harmful. Studies show that as many as 98,000 patients die in America's hospitals each year from avoidable medical errors (Institute of Medicine 2000). Here are a few other examples of the aberrant performance of our system: [] Only 20% of care is based on the results of scientific clinical trials (Heptonstall 1999; Renckens 2002); [] Only half of the 100 million antibiotics prescribed annually are necessary (FDA 2003); [] 400,000 unnecessary Caesarean sections are performed annually (Kaiser Family Foundation 2003); [] Only half of diabetics receive adequate care (McGlynn et al. 2003); [] Medication mistakes injure more than 1.5 million people per year (Institute of Medicine 2006); [] 15 million incidents of medical harm occur in U.S. hospitals each year (IHI 2006). Obviously, we do many things well. And many observers struggle to understand how things could be so bad when they are told we have the best health care system in the world. The answer is simple. Although these problems are only a part of the system, they are big enough to threaten the viability of the whole. They do enough damage to make Americans uncertain about the quality and safety of the care they actually get, and they contribute greatly to making the system ultimately unaffordable. The good news is that thinking about the system from the perspective of the way it performs shows us that its problems, taken individually, are not impossible to solve. Tackling these issues doesn't require Nobel Prize winning discoveries; it mostly requires that we put in place what we already know works. …