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Access to What Kind of Health Care?

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HEALTH CARE ACCESS
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Health care has become a political football that is being tossed back and forth by both sides in Washington. And it's divided our country. But are we even having the right debate?

The fact is we do have a choice to make -- between a disease-care system and a true health care system. This is a choice that goes beyond the ballot box and affects both the fiscal and physical health of our nation.

Most of us know the bad news: Our health care system is in critical condition. Few of us know the good news: We can indeed choose a healthier future.

In the Affordable Care Act, Congress provided access to medical care for nearly 30 million uninsured Americans. Access is critically important, but offering access to an already broken system won't provide a lasting cure. We need to ask and answer the underlying question: Access to what?

What Americans desperately need is a way to transition from the current system, which is fragmented and focuses on high-cost, high-tech interventions after illness strikes, to a modern system that delivers coordinated, high-touch, lower-cost, patient-centered care with an emphasis on primary care and prevention.

Finding this new balance will require a dramatic shift in attitudes and behavior by all stakeholders (i.e. every American). In directing ESCAPE FIRE: The Fight To Rescue American Healthcare (a new documentary film out now), Susan Froemke and I explore how our system is broken and why it doesn't want to change. But we also highlight pioneering leaders and courageous patients across the country who are implementing solutions:

A program developed by Dr. Dean Ornish at the Preventive Medicine Research Institute -- now reimbursed by Medicare after a 16-year struggle -- combines exercise, diet, stress reduction, and social support to prevent and potentially reverse heart disease. At the Pentagon, there's a special task force within the office of the US Army Surgeon General dedicated to using alternative techniques like meditation and acupuncture to wean injured veterans off heavily addictive narcotics used for pain and PTSD.

The Cleveland Clinic -- which both President Obama and Gov. Romney praised in Wednesday's opening debate -- has a team-based approach, puts its physicians on salary, and rewards them for quality, not quantity. At the University of Arizona, Dr. Andy Weil re-trains doctors in preventive medicine and advocates for treating a patient as a whole person rather than as a bionic sum of specialist and sub-specialist parts. Safeway and other corporations are starting to provide incentives for their employees to lose weight, reduce blood pressure, and stop smoking.

These are some solutions, or "escape fires," already at hand, and many more could be implemented around the country. The term "escape fire" is actually a metaphor comparing our broken health care system with a forest fire that ignited in Mann Gulch, Mont. in 1949. Just as the health care system today lies perilously on the brink of combustion, the forest fire, which seemed harmless at first, was waiting to explode. A team of 15 smokejumpers parachuted in to contain the fire, but soon they were running for their lives to the top of a steep ridge. Their foreman, Wag Dodge, recognized that they would not make it.

With the fire barely 200 yards behind him, he came up with an ingenious solution. He took some matches out of his pocket, bent down, and set fire to the grass directly in front of him. Soon after, he stepped into the middle of the newly burnt area, calling for his crew to join him. But nobody followed Wag Dodge. They ignored him, clinging to what they had been taught. The fire raged past Wag Dodge and overtook the crew, killing 13 men and burning 3,200 acres. Dodge survived, nearly unharmed.

Dodge had invented what is now called an "escape fire," and soon after it became standard practice. As Dr. Don Berwick, who came up with this metaphor, says in our film, "We're in Mann Gulch. Health care -- it's in really bad trouble. The answer is among us. Can we please stop and think and make sense of the situation and get our way out of it?"

To do so, we need to get beyond political bickering and convince Americans that we each have a choice to make about our health care future. It's a choice that lies in the hands of individual citizens, clinicians, businesses, and communities willing to come together to fight for a true health care system, not the silo'd, costly, disease-care system we have now.

Let's stop running up the hill, needlessly sticking to the status quo, and start implementing the escape fires that are right in front of us. It's going to take each of us coming together to muster the strength to look in the mirror and ask, "How can I help create a sustainable health care system for the 21st century?"

For more by Matthew Heineman, click here.

For more on health care, click here.

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