Quality With A Capital Q
"Who ever thought that
An unabashed and droll cheerleader for health care, Hughes is a
"A nation's health delivery system is a function of the values of the people of the nation," Hughes said. "That is why we are different from the Canadians. That is why we are different from the British. And I would argue that's why we're always going to stay different from them. We will not become a single-payer. That is not in our future."
Historically, the health care system has gone through phases of change, he said.
As health care cycles through phases, it is in a constant state of tension between the values of equity and efficiency, driven by the issues of access, cost and quality, he said. "Health care systems are in a constant state of change," he said. "They go through phases, but as they go through phases, the rate of change in those phases varies. How do we balance these two values as we move forward?"
Health insurance, which grew after World War II as a way to attract employees during a time of wage freezes, has intervened in the marketplace, he said.
"Consumption goes up, and you get excess consumption. When you have excess consumption, you have excess cost. One party's cost is somebody else's profit," he said. Excess revenue then leads to bigger institutions and more doctors going into specialties where subsidies are bigger.
"I will caution you with the Democratic victory in the last election; we are entering a period now of potentially accelerated change. And how that change is going to turn out is going to be a function of the next presidential election," Hughes said.
The difference today lies in society's view of quality in health care, Hughes said. Society must decide whether to maintain that trend — and Hughes said he thinks it should. But if so, Americans must be willing to raise taxes or forgo wage increases in exchange for health care.
Hughes argued that American health care is the best the world has ever seen, but still serves as "the local punching bag" for politicians, business and pundits. "How might we counteract these perceptions, because these perceptions are what drive public policy," he said. He urged the doctors to reach out to their communities to provide positive messages about health care.
Hughes pointed to the dramatic decline in heart disease mortality since the 1960s.
"This is a triumph. Medicine is delivering the goods," he said. "One by one, through biotechnology, we're going to knock them off. We're going to knock off Parkinson's disease. We'll get Alzheimer's. One by one. It's said the golden age of medicine has passed. We're not even close to what we're going to be able to do."