I had the pleasure last week to speak on the main stage at the Transform Conference sponsored by the Mayo Clinic in Rochester, MN. There were lots of very interesting presentations on design and care reform ideas, but virtually all trying to make marginal improvements on the current system. I tried in my talk to contrast this with our work at Iora trying to rebuild the system from scratch. The whole talk is available here but here’s the beginning:

Imagine for a moment it is 1902, and we are standing in New York and want to get to London in less than a day. All we have are ships, and even the fastest will take a week. We’d be tempted to call the ship builders together for an innovation conference, perhaps a little like this (but without the modern special effects). We would make grants to better understand the tides and currents, and work on streamlining the hulls, and building ever more powerful engines. But we know now this would not work- even today over a century later the fastest ships take 3-4 days. What we need of course is not to make incremental changes on boat design, but to truly innovate- to build an airplane that can fly over the sea.

I would propose we are at a similar moment today in health care. Our current system performs embarrassingly poorly. The experience of care is too often awful; we wait too long, suffer too much, and are robbed too often of our dignity. Outcomes are shockingly inconsistent- with error rates at alarmingly high levels- for instance the average 30 day readmission rate for Medicare patients is almost 20%. And much of this is at obscenely high costs that are bankrupting individuals, companies and our nation. For instance a friend of mine without insurance recently went to a primary care doctor at the local teaching hospital for a fairly trivial acute issue and had a few simples tests done, and her bills totaled over $1800 for less than 45 minutes of total time spent.

“Between the healthcare we have and the care we could have lies not just a gap but a chasm”, not my words but those of the non partisan Institute of Medicine in 2001. Crossing this chasm is like trying to cross the Atlantic in a day instead of a week; and so if we are serious about improving our health care system, we need to stop putting all our efforts on studying the tides, streamlining the hulls, and building more powerful engines, and instead have the courage to try to build airplanes.

That what we are trying to do.