Health Matters


Feb 20, 2014

heart jigsaw puzzle

This commentary originally appeared on The RAND Blog on February 20, 2014.

I have been studying the health care system for almost my entire adult life. On one level, things have changed little during that time. I joke with friends that if someone had hit me over the head 30 years ago when I started my career and I woke up today I would still be grappling with the same problems, only things would have gotten a lot worse.

Thirty years ago, health policy analysts and others were wringing their hands over the facts that we were spending approximately 9 percent of our gross domestic product on health care and that there were almost 30 million people without insurance. Today, those numbers have grown to 18 percent and roughly 50 million (at least until the Affordable Care Act is fully implemented), respectively.

Yet even after years of research into a broad array of health policy issues, looking at aggregate data, examining complicated statistical relationships, and trying to make sense of what we loosely call the health care system, it wasn't policy analysis that gave me a full appreciation of the opportunities and challenges associated with achieving better health in the United States.

Instead it was my recent heart attack.

I have emerged (thankfully) from my up-close-and-personal experience with the health care system awed—both by its capacity for excellence and its potential to create disaster. What became ever clearer to me through my experience is that for the system to truly function like a system—a connected entity whose parts work in concert with each other—there's much we still need to do.

Although a missed diagnosis by my former primary care physician almost cost me my life, my recent experience in the hospital emergency room, intensive care unit, and follow-up care illustrated how an integrated system of care can work. I observed various providers communicating with each other to ensure that I received the best care possible, and I saw that electronic medical records really can improve the flow of such information.

These two areas, better coordination of care and giving patients a greater voice in their care, have long been cited as among the most critical in building a better system, and in building better health. I was repeatedly impressed by the ease with which my cardiologist, my new internist, and other health care providers were able to access my medical history, tests, and procedures. I also relished the chance to have access to that information and to be informed of my test results through both a web site and email. All of this raised my confidence in the health care system's potential to behave as a true system. Unfortunately, however, it functions that way all too infrequently. I was lucky to have access to one of Los Angeles' largest health care systems that, at least on that day and in my case, was playing at the top of its game. Still, I recognize that too many patients, both in Los Angeles and elsewhere, are not that lucky.

The truth is that good health depends upon more than just having access to a well-functioning health care system. In fact, access to health care provides no guarantees of good health. President Obama's health care reform law will do much to increase rates of insurance and improve access to health care, among many other things, but it is not a panacea. You cannot legislate good health, and receiving care is not the same thing as improving health (though it's certainly a critical part of it).

There is no doubt that the health care system saved my life, but it became clear to me that others were critical in helping me to regain and now maintain my good health. I was touched by how friends and family worked hard to impress upon me the importance of modifying my diet, engaging in daily exercise, and reducing my stress level. But not everyone is fortunate enough to have this type of social support, and for those who don't accessing care alone may not result in improved health outcomes.

Maintaining our collective health and well-being is, and should be, a shared responsibility. There are certain things that we should look to the health care system to furnish—namely access to efficient and effective care—other things for our employers to either provide or encourage, and still other things that we as individuals must be responsible for, including our own health habits and having a voice in the care we receive.

Everyone should take the time to ask themselves what they can do to improve their health, and to support the health of friends, families, and communities. When it comes to good health, it takes a community.

Jeffrey Wasserman is vice president and director of RAND Health and professor of public policy at the Pardee RAND Graduate School.

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