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Dear Obama: A Letter About Health-Care Reform

Working to change the system that's already there is not enough. We need a complete overhaul of our health-care model

Dear President Obama,

As a concerned medical professional, I am gratified that health-care reform will have such a high priority in your new Administration. It was especially pleasing to see that one of your very first Cabinet selections was Secretary of Health & Human Services.

You have spoken often about the flaws in the U.S. health-care system and the grave risks, in both human and fiscal terms, associated with not correcting them. As a current hospital CEO and former heart surgeon, I'd like to share my perspective on today's health-care problems and recommend a course of action.

According to your Web site, "the Obama-Biden plan&builds on the existing health-care system." With all due respect, I believe that simply adjusting our current model would be a mistake similar to the one the Clintons made when they tried unsuccessfully to reform health care early during that Administration. We can't simply tweak elements of the system while leaving the rest intact. It's time to overhaul the entire model.

To start fresh, we need to clarify the three basic concepts of every health-care discussion: access, cost, and quality. We need to answer the following questions:

How should we define access? Should every U.S. citizen have a primary care physician? Should anyone on U.S. soil at any given moment be entitled to medical care? Should the elderly and the very poor continue to have access that others do not? Does "access" define all medical care without reservation?

How much should health care cost in the U.S.? Is 20% of gross national product acceptable (the level we expect to reach by 2016, if the present system remains unchanged), or should we aim for less? How much of that cost should be borne by employers, and how much by the government? What should an American family reasonably pay for health care?

Where should we set the parameters for quality? Do we want to shoulder the tremendous costs of medicine that meet the very highest standards? What should be the goals for infant mortality, cancer survival rates, and other such metrics?

Defining access, cost, and quality will set the baseline requirements the new system must satisfy. These conditions, rather than any vague goal such as "universal care" or "affordability," should be the starting points for reform. Without them, any plan will soon hit financial and demographic obstacles that will derail it completely.

Arriving at consensus on such basic yet critical questions will not be an easy feat. That's why I suggest you launch a kind of 90-day Manhattan Project as soon as possible. Invite 50 to 70 of our country's smartest thinkers—people willing to spend three months in Washington—to solve what is one of the biggest domestic problems facing the U.S. today. Avoid policy wonks and business consultants, simply because the economics of health care differ so radically from those of other industries. Station the National Guard at every entrance to the meeting room and instruct them to keep out all lobbyists.

Who should be on this "A-Team?" Obviously, you'll need to select representatives from the relevant groups: physicians and hospital administrators, insurers and drugmakers, as well as legislators and their constituents. But two-thirds of the conferees should be crossovers, such as doctors who left their practices to run hospitals or administrators who switched to insurance. That way, they'll speak each other's languages and be equipped to talk from both sides of the table. Fortunately, many highly regarded individuals fit those descriptions, including former Senate Majority Leader Bill Frist, who has gone back to practicing medicine.

The IT Factor

In addition to building consensus around the baseline questions, it is vital that we understand that information technology may ultimately be the most important element of health-care reform. While I applaud your five-year, $10 billion IT spending plan, I'm afraid it will barely scratch the surface of the nation's need for medical data sharing. My six-hospital chain alone is budgeting $73 million over the next three years to upgrade its medical-care technology.

People talk about the potential cost-savings of integrating medical IT so that hospital computers can communicate with one another, as well as with primary-care offices and with imaging labs across the country. But the real payoff from IT investment will be the birth of truly preventive medicine. Imagine an integrated system that lets us identify populations at high risk for conditions such as hypertension or diabetes and thus encourages intervention before patients get sick, instead of just before they need high-risk, expensive procedures like cardiac surgery or foot amputation. Effective data sharing will give researchers the tools to reach that level of analysis. We should no longer define prevention as lifetime treatment of chronic disease.

Predictably, the companies now competing in the medical data field will balk at cooperating to such a degree. And, finding answers to the basic baseline questions will no doubt result in strenuous argument. But, those are hurdles project members can clear. While the plan they produce won't please everyone (truthfully, it should completely please no one), the ultimate objective must be an agreement that transcends all vested interests. I firmly believe that, just as the greatest American minds could put people on the moon and invent the atomic bomb, they can also create a world-class, sustainable health-care system.

When the panel emerges with a plan, it must be followed immediately by a transition time line—perhaps six to seven years—during which an initial pilot program would expand in an orderly fashion, piece by piece. But it's imperative that this process begin right away. If we don't tackle health-care reform within weeks of Inauguration Day, the will for change that has built up so powerfully during your campaign will quickly evaporate. This is an opportunity our nation can ill afford to squander.

Dr. Ralph de la Torre is chief executive of Caritas Christi Health Care, New England's second-largest hospital network. He was formerly chief of cardiac surgery at Beth Israel Deaconess Medical Center in Boston.

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