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Bill George

Harvard Business School Professor, former Medtronic CEO

America Needs a Health Care System

America Needs a Health Care System,
Not a Sick Care System

The headlines with bad news for Americans about our health care system never seem to abate: “Health care costs hit record high.” “Health outcomes decline again.” “A record 45 million Americans lack health insurance.” A recent study published in the prestigious New England Journal of Medicine found that only 55 percent of U.S. patients receive proper medical care.

Yet in America we are blessed with the finest health professions and a myriad of private and government-funded health plans. What explains this seeming paradox? While the individual elements of our health care system are excellent, the system itself is badly broken. The reality is that we do not have a health care system that encourages people to be healthy. We have a sick care system with no rewards for helping patients prevent disease and few consequences for people who abuse their health.

Our system reminds us of the story of the five blind men and the elephant. Each of the five touched a different part of the elephant’s anatomy and described an entirely different being, but no one realized it was an elephant. The same is true with our health care system: no one is looking at root causes of the system’s problems. Instead, we are tinkering around the edges rather than addressing the underlying assumptions in order to transform the system from sick care into genuine health care.

What are the root causes of the problem? Let’s consider these realities:

1. Our system focuses on disease, not on wellness. Less than two per cent of our health care dollars go into maintaining health and preventing disease.

2. We focus on curing, instead of healing, even though 75% of our dollars are spent on chronic diseases for which there are no cures.

3. Financial incentives are for tests and procedures, not health outcomes.

4. We do not treat the whole person, failing to harness the healing powers of the body, mind and spirit.

5. We intervene late in the course of disease progression, when illness is less reversible and the cost of treating it is far greater.

6. Productivity standards such as reducing physician time per patient visit discourage physicians, nurses and hospitals from taking the time to get beneath surface symptoms to the deeper causes of patients’ problems. Physicians today average only seven minutes per patient.

7. Patients are encouraged to be passive recipients of their health professionals’ ministrations, as the medical system does not emphasize patient empowerment and partnering. Yet lifestyle behavioral choices influence the trajectory of chronic illnesses.

A new approach is required, one that focuses on the whole person and empowers people to take responsibility for their health. Called integrative medicine, this approach focuses on wellness and preventing illness while integrating the best elements of conventional medicine with complementary therapies drawn from other healing traditions. Integrative medicine is patient-centered, emphasizing partnership and collaboration between patients and health professionals and offering genuine choices in healing.

Rather than looking at the patient as a diseased body part, integrative medicine sees a whole person, connected in body, mind and spirit with immense powers of self-healing. It believes that all aspects of patients’ lives need to be addressed in order to become and stay well. It emphasizes new models for treating chronic illness, recognizing that episodic care is an expensive and ineffective revolving door.

Concurrent with this shift in focus, we need fundamental changes in the way health care is reimbursed. There is essentially no reimbursement for maintaining health and preventing disease, and few limits on payments for treating disease. In most instances co-pays are so small that they have little or no influence on health behaviors of individuals. This must change, or we will continue on an ever-upward spiral of cost escalation until as a nation we simply cannot afford quality health care.

What is the cost impact of integrative medicine? We believe integrative medicine will deliver more effective medicine at a lower cost than current care. By preventing or delaying the onset of chronic diseases, the cost of treating chronic disease will decline. By doing what they can for themselves, people with chronic conditions will be better equipped to avoid recurrences.

To bring about these changes in behavior, Medicare and the nation’s leading insurers should work together with leaders in integrative medicine to pilot innovative reimbursement programs to address chronic conditions holistically. For example, chronic pain, diabetes and heart disease are three conditions that offer immediate opportunities to use integrative approaches to demonstrate improved patient outcomes and cost reductions.

Minnesota is leading the nation in the development of integrative medicine, just as it did with health maintenance plans thirty years ago and innovative medical procedures such as open heart surgery, multi-organ transplants, and spinal surgery. For the past decade the University of Minnesota, Abbott-Northwestern Hospital, Mayo Clinic, the Marsh, and United Health Group have been pioneering new ways of treating the whole person.

The University has been a national leader in training health professionals for integrative medicine. Through its Institute for Health and Healing, Abbott Northwestern Hospital is delivering nearly one thousand in-patient integrative treatments per month to seriously ill patients. While Mayo is researching the effectiveness of integrative therapies, the Marsh is a national model for integrative wellness centers. United Health Group is pioneering reimbursing therapies such as acupuncture and chiropractic care as they are shown to be effective.

To increase the awareness of the general public of how medicine is changing, Twin Cities Public Television (TPT) has produced a two-hour nationwide special called “The New Medicine” that describes integrative medicine and shows how the principles behind it are changing our nation’s leading medical institutions. It will air this Wednesday, March 29, from 7-9pm , followed by a panel featuring local experts examining “The New Medicine in Minnesota .” TPT’s website for the program is www.thenewmedicine.org.

We are nearing the tipping point when the evidence of the benefits of integrative medicine will become so clear that “the new medicine” will be recognized as the best – and only sustainable – approach to addressing the root causes of the health care crisis. By adopting this new medicine, we have the opportunity to heal the healthcare system itself.