"To Improve Is to Change": Improving U.S. Healthcare

Sir Winston Churchill is quoted often to have said, “To improve is to change; to be perfect is to change often.” Given this pithy observation, can we conclude that healthcare is certainly going to improve because it is certainly changing? Medicine is experiencing rapid and often times confusing changes. Many physicians are not prepared to deal with sweeping policy changes in healthcare, such as healthcare delivery innovations, quality improvement with cost reductions, primary care and now population health, to name a few challenges. The idea for a health policy symposium in the Journal resulted from our perception that there is considerable confusion, dissatisfaction and even turmoil as physicians and health leaders react to the evolving health policy changes generated by business and political leaders. Physicians do not always welcome such change; do not often embrace health policy issues; and consider the intersection of policy and politics as something toxic to avoid, rather than something to engage, influence and guide! Several issues such as primary care, physician workforce, health disparities and physician reimbursement are recurring policy and practice concerns that we never seem to resolve fully. Still other issues have achieved heightened visibility and importance recently, such as the new focus on population health, the increasing challenges posed by the value equation (quality and cost) and the promise of improved information technology. Beyond the clinical enterprise, ongoing concerns about the slow pace of innovation in medical education and the lagging federal investment in biomedical and health-related research are again pressing policy issues. Appropriately, one might ask why we do not resolve these policy issues, or at least adopt systems approaches that address such critical issues in a constructive, proactive manner, rather than dealing with them in a recurring reactive or crisis mode. Could the answer be right in front of us? As a country, we have not implemented effective systems in healthcare, and one consequence of our disordered approach is recurring, unresolved policy challenges.