Health Care Reform in America


Wilson_edited-1(22.04.13)  “Only you can save America.”

With that wake up call Dr. Ezekiel Emanuel began his keynote address to the audience of 4000 physicians attending the opening session this month (April 11) of the annual scientific meeting of the American College of Physicians in San Francisco.

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Ezekiel J. Emanuel, MD, PhD, University of Pennsylvania, Philadelphia, USA 

Dr. Emanuel’s theme was the high cost of health care that in his words threatens “everything we care about”. He went on to emphasize the importance of physicians’ role saying: “More than any other group in America, doctors have the power to solve our long-term economic challenges to ensure a prosperous future.”

The nearly $3 trillion spent in the US on health care annually would, if it were a country, make it the fifth largest ranking behind only the US, China, Japan and Germany. Just the federal portions of Medicare and Medicaid make it the 16th largest economy in the world, larger than the economies of Switzerland, Turkey or the Netherlands.

Expenditures on health care represent 17 per cent of the gross domestic product and are getting larger and larger. The impact of other variables in the US economy is far exceeded by the cost of health care. According to Dr. Emanuel, this is not sustainable.

Dr. Emanuel listed six of what he suggests are essential ingredients to transforming the health care system. 

  1. A focus on cost and value
  2. A focus on patient needs
  3. Clinicians working as teams, including allied health professionals
  4. An emphasis on organizations and systems with changed incentives
  5. Standardization of processes
  6. Transparency around price and quality

Dr. Emanuel emphasized that the US economy and future prosperity are closely connected to needed changes in health care. He point out that previous efforts at reform that did not have physician leadership failed. To make that point he said to the audience of physicians in San Francisco: “If you don’t do it, it ain’t gonna happen. It’s that simple”. His final admonition was to point out that no one should expect reforming the “sixth largest economy” in the world could be accomplished in a few years.

My Father the minister used to talk about the time toward the end of his sermons where he would deliver the “exhortation”. He described that as the call to action, when he would deliver “urgent advice and recommendations”.

Dr. Emanuel has used hyperbole in its best sense to exhort physicians to be involved in health system reform in the US – to not only see their patients one by one, important as that is, but also to advocate through the political process to create an environment, a milieu if you will, that is conducive to providing the best possible care.

I agree with Dr. Emanuel about the essential role physicians must play. I also understand it will not be easy. And, physicians will not be able to change the system alone.  It is a job for all stakeholders in the health care system. It will take everyone working together as a team. And fortunately working as a team represents the best of health care for the future.

Ezekiel J. Emanuel, MD, PhD is chair of medical ethics and health policy at the University of Pennsylvania, Philadelphia, USA. He served as special adviser for health policy to the director of the federal Office of Management and Budget in 2009-11 during the design, passage and first steps to implementation of health system reform embodied in the Affordable Care Act, passed by the US Congress in March 2010.

The American College of Physicians (ACP), the national organization for internists, with 130,000 members is the largest specialty society in the US and has chapters across the US and around the world. Its stated mission is “to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine”. In 2002 it was my privilege to serve as Chair of the Board of Regents, the policy making body for ACP. At the meeting in San Francisco I represented the World Medical Association.

WMA President Cecil. B. Wilson, MD travels around the world talking about the WMA's work representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavors to achieve the highest possible standards of medical care, ethics, education and health related human rights for all people. This blog will chronicle these travels and important issues.