Can fixing what's broken in an ailing healthcare system create a model for everything else that's going wrong in this country, and around the world?
As we come to the end of another fun-filled year in healthcare, so many conversations have been started about things we need to do, about ways we need to change, about how we can possibly do so much better.
We've been functioning in a system not truly of our making, a healthcare system that in the end doesn't do its best for everybody, and we have seen these divides highlighted and widening throughout this year like almost no other time before.
Almost without exception, we all have in mind an idealized healthcare system that works for everybody, every time. In our heart of hearts, we know what this would look like.
None of us would wish the healthcare system we have on our worst enemies, and we all wish for a healthcare system that would do for everybody as we think it should for those closest to us -- for our loved ones, friends, colleagues, and community.
It's time we built something that brings everybody along.
We have to create a system that lets everybody have equal access to the best care, the right care at the right time, and figure out how to make this system blinded to someone's ability to pay.
True, in a capitalist system, there will always be haves and have-nots, and there will always be those who wish to pay more for premium services. But if we make the basics the best we possibly can, if no one gets denied what they truly need, if no one ever needs to choose medications over food or rent, then we will probably have gone a long way towards making things better.
We need to expand access, we need to build up the primary care foundational workforce that drives the healthcare system, we need to pay a living wage across all medical specialties (so that our brightest minds don't opt out of a career that is seen as less prestigious because of the lackluster image that has been foisted upon it), and to all members of the healthcare team.
We need everybody in this system working towards a common goal, taking care of our patients and making sure that all of those working in healthcare are taken care of as well. In every way.
Right now, in this country and around the world, things look pretty rough.
It seems that nobody can agree on anything, and that any time anybody has an idea, there is an upwelling of ideological opposition that ends up with no winners, and a toxic environment that discourages discussion and the exchange of ideas, cooperation, or finding effective solutions.
Everything from vaccines and mask mandates to global warming and the fight for clean water, from affordable housing to a decent living wage, to an equitable education, to a just system of justice, has devolved into a shouting match from which it feels we might never emerge.
In healthcare, we have been taught to do no harm, to seek to do our best for each patient before us, and to then think about expanding that care outward to other patients like them, and then to their communities, and to the nation as a whole.
If we can stand up and fight for this, if we can demand an effective system of public health with active surveillance and disease tracing, and an intelligent system of screening and prevention, and unlimited access to timely care and telehealth opportunities, and no limitations imposed on patients by their ability to pay, then perhaps we have a chance to translate this into solutions for the rest of the things that are ailing us.
As this year comes to an end, as we head into the final week with our front lines once again burdened by a devastating surge of cases in a decimated workforce beaten down by 2 years of the pandemic (and with many currently sitting at home with suddenly positive swabs), I know it's asking a lot to request that we redouble our efforts, that we raise our voices, that we no longer take no for an answer.
Not only is our healthcare system failing, but this type of affliction has spread across so many other parts of this country and across the world, and if we don't do something now, things are likely to only get worse.
So maybe if we stand up and fight, maybe if we demand change, maybe if we start telling people in power that we know how things should be done and what they're going to do to help us get it done, then we all might have a chance.
I wish us all a healthy and happy and just and equitable New Year.
, of Weill Cornell Internal Medicine Associates and weekly blogger for 51˶, follows what's going on in the world of primary care medicine from the perspective of his own practice.