REFORM: New England Journal's Perspective on Change

The New England Journal of Medicine broke with a 117-year tradition. Instead of taking its traditional form, the annual Shattuck lecture was a panel of 13 people from various academic disciplines, health sectors, and political perspectives discussing "Health of the Nation—Coverage for All Americans." It's all available (the video, excerpts and related articles) free online to nonsubscribers. Accompanying it is a perspective by UNC-Chapel Hill's Jon Oberlander, recapping the respective health plans of John McCain and Barack Obama, and an editorial by three top NEJM editors.

A lot of the interesting comments (and to be honest, I'm talking about the excerpts. I haven't yet watched the whole video) didn't stress financing insurance as much as they focused on fixing the health care system. The conversation was about how doctors perceive the system, what patients need, and how we can't meet those needs without revitalizing primary care and changing how we pay doctors.

The speakers were not completely optimistic about comprehensive reform coming forth from Washington, but they did recognize that 2009 might still be a catalyst for positive change. Dr. Reed Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group in Minneapolis said:

"If you want to actually get something done in Congress, what it's going to require are multiple different stakeholders who are all prepared to go for their second choice. What is frustrating is once you get beyond the moral outrage, what happens is that every sector—the private insurers, the manufacturers, small business, the advocates for individuals—everybody has got their own 18-point plan. And what we have learned, over and over again, when people get wedded to those fundamentals, is you never get to the calculus of actual legislation that can get passed."

The editorial said, "The time is right for reform. The opportunity is here, and the need is clear." The editors called on the academic medical community to take a step beyond their well-established calls for more access to care, and get serious about how to address the costs. And they called on doctors and other health care providers "to show in reducing inefficiency in health care. "  Which means be open to changing how they themselves practice medicine—and finance their practice.