A final word on healthcare

I learned so much writing nearly 350 columns for Modern Healthcare during the past eight-plus years. As Queen’s Freddie Mercury once sang: “Bad mistakes, I’ve made a few.”

Perhaps the most regrettable came in January and February of last year when I, like so many others, failed to raise alarms about the emerging threat from SARS-CoV-2. When I finally wrote “better late than never on pandemic preparedness,” I called on healthcare leaders to “speak out about any and all inadequacies they see in the nation’s system for fighting infectious-disease outbreaks.”

The timing was off, but the advice was sound. Its tone reflected what I tried to keep in mind whenever I sat down to write my weekly column. It is readers of this magazine who hold the levers for shaping events, not pundits like me.

I hoped my opinions would be helpful to those with influence and decision-making power. I also understood my advice had to be more than far-reaching—it was my luck to opine through an era of enormous challenges. It had to be practical.

It’s been my privilege to meet many top healthcare leaders. These men and women (who are better represented in this industry than others, but it’s still not enough) are our audience.

They sit atop organizations that collectively make up 18% of the nation’s economy. Their pragmatism is driven by the necessity of maintaining continuity of service for 330 million Americans. And they must protect the 16 million people who look to the system for their careers and livelihoods.

Yet I never stopped pushing the system to do better. I backed the Affordable Care Act’s compromised approach to reaching universal insurance coverage, of course. But I also urged faster action on payment reform, care coordination and health information technology interoperability. I defended reform from its attackers, both before and after the Trump administration.

I gave credit where credit was due. I cheered the progress in improving hospital safety. I was among the first to celebrate the slowing rate of healthcare spending—years before the Congressional Budget Office or CMS incorporated it into their projections.

I have regrets. I didn’t do enough to highlight the gross disparities in health outcomes in our society or the social determinants of health that drive those disparities. Racial injustice, lack of affordable housing, food insecurity, environmental degradation and a higher minimum wage are health issues, too. These are the great challenges that face healthcare’s leaders in the years ahead.

In 1980, the late Dr. Arnold Relman, then editor of the New England Journal of Medicine, popularized the phrase “the medical industrial complex.” Too often, as I noted in many columns, the special interests that make up that complex do more to defend an imperfect status quo than advance the public interest, which demands changing our fragmented healthcare system into one that delivers higher-quality care to every person who needs it at an affordable price.

That is the “triple aim,” a concept I first learned from Dr. Donald Berwick, who led the Institute for Healthcare Improvement in the years leading up to passage of the ACA. I had just written a book about the drug industry and launched a blog called GoozNews, which had succeeded in winning an influential readership. That blog, which I recently relaunched, helped bring me to the attention of Fawn Lopez, publisher of Modern Healthcare.

This final column brings me full circle. I thank her and the organization for providing me this platform. I hope I’ve served you, our readers, well.

We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.

—T. S. Eliot



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