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Wellness and the Governing Dynamics of Healthcare Reform

November/December 2009, Vol 2, No 7 - Editorial
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On October 29, 2009, a leadership summit on healthcare reform was in progress in Washing ton, DC. No, not Congress; the participants were not Democrats and Republicans locked in a death grip to impose, or block, government-mandated healthcare reform. This was a conference of leading healthcare authorities representing clinical, business, and policy sectors in healthcare, organizing the elements of a strategy to reform healthcare into a new paradigm that improves health, reduces costs, and encourages innovation—that endangered species of the healthcare ecosystem.

The occasion was the 2nd Annual Summit on Stakeholder Integration of American Health & Drug Benefits (AHDB), and the theme was the changeover to wellness-based system for chronic diseases, focusing on prevention, intervention, and innovation. The summit was marked by the nonpartisan environment and exchange of ideas and data and the compelling nature of the information. The summit experts were using the highest principles of medicine, science, economics, business, and policy to craft an organizing principle for healthcare. Not evidence-based medicine or benefit design, not comparative effectiveness research, not personalized medicine. These are only tools to be used in the grander, simpler vision for how health, not just healthcare, must proceed.

What makes wellness-based healthcare so important at this time of national angst is that it answers the essential governing dynamics of value-based health— cost, quality, and access. Moreover, wellness is intrinsically apolitical, providing an opportunity for consensus in healthcare policy, because wellness does not exist in a vacuum within policy but extends to the other 2 sectors— clinical and business.

But wellness is not a silver bullet; it sets out on its journey incompletely informed—nothing new to healthcare. The various stakeholder groups have been devising new systems that enable the prevention of chronic diseases, a more efficient management, and new technologies for treatment. These have been happening spontaneously, the inevitable result of progress in the many parties comprising the great "healthcare ecosystem." They need only be arranged coherently.

Armed with vital new information on the nature of disease, insurance, policy, and people's peculiar resistance to self-preservation (as manifested in poor adherence to treatment regimens and strong adherence to a sedentary lifestyle and juicy hamburgers), healthcare professionals are in a position to organize these findings into a coherent, actionable program to improve health and reduce waste spending. This program, called "wellness," will entail the reinvention of every stakeholder— payers, purchasers, providers, patients, manufacturers, researchers, and policymakers. Change is not easy, but incessant incremental, patchwork changes to the existing healthcare system is getting intolerable. This is not a "system"; at last year's AHDB summit, a comparison was made to Voltaire's great remark about the Holy Roman Empire being "neither holy, nor Roman, nor an empire." A paradigm shift was needed to the political organization of the Holy Roman Empire, if it were to offer political relevance.

Our own shambles of a healthcare "system" is sufficient cause to inspire change, but to what? Out of the frying pan into the fire? The American healthcare process is saving countless lives and must not be abandoned wholesale. And the insistence on controlling one's individual destiny, sometimes derisively referred to as "American exceptionalism," has something to it. The proceedings of the wellness summit will be published in a special supplement to AHDB in early 2010. We hope it will offer the various stakeholders actionable steps to bring together the great forces and groups charged with administering, monitoring, and protecting the process of patient care. Meanwhile, we might resist the urge to authorize the government to reign supreme in health, not its strong suit or its tradition. The danger to health is evident in a quote from the statesman Thomas More, "If the world is round, will the King's command flatten it?"

Government mandate is not a good way of managing health. In contrast, wellness-based healthcare provides a rational organizing principle for medicine, business, and government to collaborate in a structure that preserves a system informed by innovation, sound medical and business practices, and good sense on the part of the populace. Let us not lose heart that such sanity is attainable. It is no longer a dream; it is coming into being and needs time, focus, and stakeholder collaboration to become a system, which we have been working without for all these years.

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