Back To The Basics

It's fall, the season for kids to return to school and for the spectacle of stadiums full of football fans. Because we understand that our kids won't get a good educational foundation unless their schools emphasize the basics, we demand emphasis on the basics. We see that winning football coaches emphasize mastery of the basics and that winning teams don't get to the superbowl because of technology or gimmicks: they get there with hard work and competence in the fundamentals of football.

Those who plan and operate our health system haven't mastered the fundamentals. They focus on gimmicks such as unproved electronic medical records, grandiose medical edifices (Freud would have explained that they have edifice envy), complex PPOs, HMOs, copayment schemes, roadblocks of eligibility criteria, constructing barriers to payment, and creating rules which guarantee large numbers of uninsured.

I suggest we think about the basics. Let's educate our kids well enough in primary and high school so that they can learn to understand the world around them. Our colleges should be more than advanced high schools: they should help their students study social and scientific principles, to think, question, and develop a lifelong commitment to learning and to developing a respect for personal integrity and ethical systems. Our medical schools should be peopled with faculty who are not only scientists, but are expert skilled physicians, nurses and other health providers and planners who understand and value clinical care and value not just "the faculty agenda" but the art of teaching. We should encouraging the brightest and best of our young people to study sciences, medicine, health care and public service in an environment free of ethical conflicts of interest.

Our students should understand how they fit into society, why they will enjoy unique privileges and opportunities, and how to deal with professional rights and professional obligations which are in constant tension. They should be taught the use of constructive self criticism and correction, which are invaluable skills in science and health care.

And only then can we start to build a health care system that makes sense.