I have asked some of my colleagues to read this blog and offer their comments. The following comes from one of the brightest thinkers in medical education I know. He is the Dean of a medical school, and I have always respected his judgement. His comments have some important implications. I ask you to read them, and try to answer the questions he poses. They will form the basis of what we will discuss tomorrow.


I’m not sure what you might be seeking, but here are some thoughts. They are largely posed in economic terms, but they have a broader implication.

1) If the solution to optimal health service coverage (universal coverage, true payment for disease prevention and management – as well as – interventions) will require major modification that will significantly impact all sectors of the business (e.g., hospitals, physicians, insurance companies, state government, big pharma, etc) in a negative manner initially, who should pay for the “cost of activation”?

2) Should the basic science research arm of medicine be amputated in the public sector (i.e., academia) such that more essential health care services can be delivered or is the basic research America’s international advantage? If the latter, how does America get the rest of the world to pay?

3) Is personal health really dependent upon community health (economic drivers, strong education, healthy lifestyles) rather than doctors, nurses, hospitals, and pills? Of course the latter help, but if the former is more important, shouldn’t our effort be on job creation? If yes, what sort of jobs? What can be done in America that is not likely to be outsourced?

4) The US economy is focused on material production and consumption. The production is largely outsourced and unless consumption is largely outsourced as well, we will have a growing trade deficit. What sort of business bring local value and create local jobs without requiring every expanding consumption. Indeed, this effort to expand consumption through marketing and mass production is one of the reasons we have such an obesity problem. What are our alternatives? Is knowledge generation valuable without a consumable product? If not, is there a future for academic institutions?

My colleague understands that health care is COMPLEX!

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