03/24/2010 05:12 am ET Updated Nov 17, 2011

The Forgotten Side Of Healthcare Reform: You And Me

If you're like me, you're kinda depressed right now. Whatever's going on in Washington, it sure seems like healthcare reform -- which a month ago seemed to be in pretty good (though far from perfect) shape -- is now on the ropes. Even if Congress does manage to put something before President Obama, it promises to be a far cry from the already compromised proposals of just a few weeks ago.


Well, don't give up quite yet. I'm not here to offer a policy analysis that punditizes on how the Beltway Brethren can sort stuff out. Rather, I've got another idea: something that's equally important to real healthcare reform in this country. And it starts with you.

For the majority of us -- those Americans not caught among the 50 million without healthcare insurance -- healthcare reform (in whatever form) wouldn't really change our day to day experience with medicine anyway. We'd still have a doctor who had too little time for us (less than 15 minutes, on average). We'd still not be entirely clear on what they were telling us to do as they rushed out the door. And we'd still be throwing up our hands at the barrage of information that seems both essential and contradictory at the same time. That's not the sort of healthcare reform I want, anyway. What I want is healthcare reform that changes my life. That changes everybody's life -- for the better.

In other words, whatever comes out of Washington, most Americans will be in the same boat: slightly adrift, and without a clear sense of who's skippering the ship. And thus, our health would stay in the same zone: worse than it should be.

But it doesn't have to. That doesn't have to be where we leave the issue.

The answer is Us. There's another side to healthcare reform that equally important to whatever happens in Washington, and it's happening -- for real -- all over the country. People are taking charge of their health; they're telling their doctors they want to be involved in the nitty-gritty decision-making, and they're changing their lives for the better. This is healthcare reform from the bottom up -- and it's the forgotten yet essential part of changing the way the US deals with healthcare today.

Bottom-up healthcare reform means engaging people in disease prevention, so that fewer people demand expensive, long-term disease management (which saves money). Bottom-up healthcare reform means informing people which screening tests they should consider, and which they should avoid -- helping spot disease earlier (which means less expensive interventions later) while avoiding those screening tests that cost big bucks (like CT scan screens) with little evidence of saving lives. And when we do come down with a disease, bottom-up healthcare reform puts people in charge of their disease treatments, so that we can assess the risks, benefits, and trauma of treatment, potentially avoiding expensive interventions which suck up resources and precious life (always, to be clear, at the behest of the informed patient).

In other words, Healthcare reform, as it has been discussed in 2009 and 2010 in Washington D.C. may be on the verge of a sad compromise. But the larger opportunity is still before us.

And it doesn't require politicians to get in gear. All it takes is us.