This is the title of a just-published book by Zeke Emanuel. It is of intense interest to me coming a short while after I published my book Next Medicine. I am eager to see how it conjoins or fails to intersect with my book, which similarly seeks to predict tomorrow's medicine.
Clearly, the frames of reference are dis-similar. I wrote my book from the remote perspective high in the peanut gallery of physicians who are intensely interested but politically detached from the clamor in Washington about the dismal status of our tattered profession. We calmly seek a Renaissance. Zeke Emanuel on the other hand has been in the bull ring contesting with the raging bull that threatens the entire nation. Zeke is a senior policy adviser in health care issues and played a central role in the creation of Obamacare. His formal credential is that of a medical ethicist. I have pondered how the ego of a medical ethicist can continue to stand tall in the face of the buzz saws that dominate the medical topography.
I cheered when Obamacare was passed. I was shamed by the fact that America was the only one of the world's advanced countries that failed to provide universal coverage for all the citizenry. Now we have universal coverage, cheers, but the critical and adjacent question is coverage of what? If Obamacare becomes an extended basis for the plunder of our individual and collective well-being then we are doomed to enduring failure.
It is my conviction that the central issue of current medicine is its fixation on repair, featuring predominantly pharmacy and instrumentation which clearly pay well. How they mesh with the needs is a totally separate and alarming issue. However now we know enough to prevent most illnesses, but we are so constrained by fixing things that we neglect the obvious strategy of prevention.
In the past few days I've seen Zeke Emanuel on the net and TV touting his new book. He speaks much of the apologies due for the miserable administrative snafus that have accompanied the rollout of Obamacare. These appropriate calls of complaint cannot be allowed however to obscure the great new value of universal coverage. This immense benefit transcends the logistical problems.
But the greater question remains coverage of what? I'm eager to learn how Emanuel addresses this fundamental issue. Concerns are raised about the new system defaulting health care to the big money guys, the Medical Industrial Complex in Relman's term. If medicine is a corporation much as with agra-business, the reform and revolution are in jeopardy. However if the new redirect concerns the emphasis on health promotion, not repair, then we are at a moment of historic proportion.
After I have had the chance to compare the Emanuel book with my own, I will be blogging to sustain the interest in this absolutely critical societal issue.
Whither medicine?
References:
I. Emanuel Z. Reinventing American Health Care, Public Affairs Books.com 2014
2. Bortz W Next Medicine Oxford Univ Press 2012 New York