How NAM Would Fix the Broken American Healthcare System

Hello and welcome. I am Dr George Lundberg and this is At Large at Medscape.

We all pretty much agree that the US healthcare system is a mess. It is way too expensive; still too many people do not have access to the right care; prevention is inadequate; far more hassle than necessary; wasteful and sometimes pointless administration and regulatory requirements (like those damn electronic health records); quality is questionable; persistent liability concerns; and uneven—sometimes unfair—delivery of services.

The Affordable Care Act (ACA), according to much hard data and a now 55% public approval rating,[1] was an improvement, although still loathed by many. The Republicans tried hard to deliver on their 7 years of promises to repeal the ACA, rapidly offering the American Health Care Act (AHCA) as the replacement. But it quickly became clear that they did not have a clue about how to actually replace the ACA, and their AHCA garnered the support of only 17% of the American public.[2]

To the Rescue: The National Academy of Medicine

Dr Victor Dzau, president of the National Academy of Medicine (NAM; formerly the Institute of Medicine)—disclosure: I am a member—charged 150 designated leaders to study all aspects of the American healthcare system and propose solutions. From that effort has come a compilation of eight "Vital Directions for Health and Health Care" with many supporting and explanatory documents: a 19-author base document,[3] the 19 accompanying topical "white papers,"[4] and the JAMA summary,[5] all in open access.

I understand that reading the following list may seem quite dull; after all, it is just words. But I ask you to trust me. These eight directions are packed with background, substance, and common sense. They are intended to remove so much of the hassle and waste that impedes your ability to get your job done and to help the entire country get a better health return for all that money we are spending.

National Academy of Medicine Vital Directions for Health and Health Care Checklist[6]

  1. Pay for value: Deliver better health and better results for all.

  2. Empower people: Democratize action for health.

  3. Activate communities: Collaborate locally to mobilize resources for health.

  4. Connect care: Implement seamless digital interfaces for the best care.

  5. Measure what matters most: Use consistent core metrics.

  6. Modernize skills: Train 21st-century health care and science workforces.

  7. Accelerate real-world evidence: Integrate clinical care data for progress.

  8. Advance science: Forge innovation-ready research and partnerships.

Make no mistake, this will not be easy. The report does not specify who will fund this or implement it. But the money is already there; it "simply" needs to be used more effectively and efficiently. President Dzau and key NAM representatives have already presented this study in person to several high-ranking politicians in the Senate, the House of Representatives, and the Administration, with initial favorable responses.

A $3.2 trillion–a-year industry that affects all Americans and employs a vast number of people is a behemoth and highly resistant to change. This system replacement must be bipartisan and command wide public support. NAM, which is not a government agency and is prohibited by its Internal Revenue Service status from lobbying, deserves and enjoys widespread respect. The leaders it commands can now endeavor to fill the vast leadership gap we have all been witnessing.

Read the backup documents provided by the links in our reference list. Study them. Try to figure out how your own organization can begin efforts to follow these Vital Directions and begin using these approaches to "brighten the corner where you are."

That is my opinion. I am Dr George Lundberg and this is At Large at Medscape.


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