Dr. John Kitzhaber, physician, former Oregon governor, health researcher and prophet of comparative effectiveness, ended a provocative speech about health care not with graphs and charts and reams of numbers but with a photograph of flowers and the words of a poet, tending his garden for the last time. He wanted the flowers to bloom, he said, for the next generation.

The flowers represent the health care system in America, and Kitzhaber, now the president of the Estes Park Institute and director of Center for Evidence-Based Policy at the Oregon Health and Sciences University in Portland, has been a prominent voice in reminding us that the problem in health care isn't just about how we pay for it. It's about how we deliver that care, how good that care is, and how we make sure people get what they need when they need it. Ordinary people don't care about "health care" per se, he reminded his listeners. They care about health.

In his keynote speech at the Institute for Healthcare Improvement conference on redesigning clinical practice and in a conversation with me afterwards, Kitzhaber was blunt. "This is a dysfunctional system and we don't have much time to fix it."

Kitzhaber wants to create a "safe space" free from the usual political stalemates and economic self-interest that have historically blocked health reform. And he wants people to just think differently about our health, to use a different mindset and vocabulary.

He likes to compare how we think about health care versus how we think about public education. We finance schools, because it is in the public interest, for our democracy and our economy. We give universal access (all kids) to a defined benefit (K-12 education). When we have a financial shortfall, we argue about benefits. We cut electives, or enlarge class size or maybe shorten the school year. But we don't argue about eligibility. We don't say, "We don't have enough money so this year we won'teach 11th and 12th grade. He'd like us to begin thinking in parallel ways about our health.

Kitzhaber doesn't see a quick fix for anything as complicated as health care. He hopes the next president will act decisively to start the country on a road to change, like John Kennedy got us on the path to the moon. But he says a true transformation into an equitable, high-quality, cost-efficient system will take a decade or more, just like it took us years to reach the moon. Step-by-step progress is OK, he said, "as long as you know your end point" and you keep taking one step and then another, working together for a common purpose.

Right now, he said, our system is locked into a 50-year old model that centers on acute crises. That doesn't work well for treating chronic disease, which eats up more than 70 percent of the health care spending. A chronically-ill person has "seven or eight physicians who don't talk to each other." They keep records on seven or eight sets of paper records, locked up in their separate offices. Patients end up not getting the care they need (or getting care that they don't need).

His message set the stage for this IHI conference which focuses on clinical practice and outpatient care. IHI usually gets attention in the lay press for its work on antibiotic resistant infections and hospital quality but there are hundreds of doctors here in Grapevine, Texas (some from as far away as Yemen and Yugloslavia) who want to learn how to run better practices, giving them more time with patients than paperwork, and giving patients the care they want, need and deserve. We'll be posting more about what folks here are saying soon.