Is health-care delivery in the United States so broken, fractured, dislocated, and disarticulate that it cannot be repaired, remediated, rejuvenated, reformed, or reorganized? Should all existing delivery mechanisms be torn down so we can start from scratch ("creative destruction")?
My unequivocal answer is no to both questions, but creative rethinking and re-visioning are imperative. Nowhere on the planet is there a "perfect delivery system" for health-care modeling as an exemplar to be emulated and, therefore, franchised to scale. In the United States, what is currently called a "system" is certainly not one in the sense of an ecosystem—i.e., controlled, sustainable, natural, with known inputs and outputs, with precise and defined resources and resource management, and with holistic feedback loops. There should also be within the ecosystem a balanced and proportionate response to all perturbations. A true health-delivery co-creation and co-design will require open adjustability and adaptability as learning and incremental improvements are added, multiplied, and exponentiated.
The current U.S. health-delivery non system does have many strengths: strong expertise at universities and other research hubs. Its free-market structure for product development and dissemination is inventive and innovative. Pharmaceutical companies and device manufacturers contribute capital and research and development to the healthcare space; start-ups are still encouraged and possible. Its safety is ensured through oversight by the U.S. Food and Drug Administration and organizations such as the Joint Commission. The National Institutes of Health (NIH) provide funding and research prioritization with accessibility by all to publications and trustworthy current research and researchers. We now also have the social networking tools (wikis, Facebook, Twitter, LinkedIn, Doximity and the like) to deploy seamless and remarkable change on the magnitude of a paradigm shift / vault / springboard / launch for more engaged participants, and search engines to ennoble access to the best information toward health and wellness prevention, intervention, postvention.
But the biggest asset of the current non system is the network of 5,010 community hospitals that deliver care to unique individuals locally, one provider to one patient in need, day or night, weekend or holiday. Thus, the United States already has the fundamental building blocks for a strong, personalized health-care-delivery ecosystem. So what else is needed?