Based on a conversation yesterday, I began to consider the problems inherent to criticism that only seeks to expose problems in a system without proposing solutions. Such criticism, – well-founded, researched, and presented – would at its best leave informed people galvanized for action. But what action? Action should be organized and directed in order to be effective. At the worst, the criticism would leave people feeling hopeless and helpless, especially for those less familiar with the inner workings of health care systems. It could potentially discourage a growing sense of empowerment that would encourage people to learn more and fight for a better future. That is of course the last thing I’d want to do.

Presenting problems in any system, then, brings up the question of whether we have an obligation to provide some form of hope. This could be as concrete as a suggested action or as abstract as a vision of what a better system would look like. Kind of in the vein of “a journey of a thousand miles begins with a single step” – should we provide a step, any step? Without entering in a rigorous philosophical and ethical discussion, in short, I think we should. From now on, when I speak and write about the problems in the system, I’m going to endeavor to provide at least the framework of a potential solution.

Of course, a potential solution to the problems in American health care is a HUGE undertaking (and one that I am only beginning to realize the magnitude of as I sat down to write this post!). Considering a theoretical perfect system seems more proactive than reverse engineering the current system.

It seems 3 main goals/themes start to emerge when I imagine a just and sustainable, prevention-oriented health care system. The specifics of these  will change as our collective knowledge improves, yet the over-arching principles should remain.

1) keep healthy people healthy

2) heal the sick quickly, efficiently, and effectively

3) provide compassionate, human-centered end of life care.

Such a system would prioritize these goals above all others. There does not seem to be any room for the pursuit of profit within this framework, yet there is a clear role for continued research into cost-effectiveness. These goals necessitate that we consider an individual as a collection of smaller systems (individual organs down to cells) but yet a part of larger systems (families up to societies and species).

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