Recently, I had the distinct honor of giving the commencement address to the school of medicine’s class of 2017. It was a great privilege to offer not only sincere congratulations to all of the newly minted physicians, Ph.D.s, and master’s recipients, but also to provide them a few insights about the nation’s health care system that I have gleaned during my 44 years at Johns Hopkins.
First, there’s no question that the United States has the best medical care in the world. That’s why people from around the globe come here for treatment. Yet it’s also undeniably the most expensive health care on the planet and fails to help many, many people in this country.
When I began my career in the early 1970s, total U.S. national health care expenditures accounted for approximately six percent of our gross national product. Today, they account for 18 percent of GNP, with a per person cost of $10,000 annually—twice what other Western nations spend. I am not sure this is sustainable.
Instead, consider these three common factors in other advanced countries where per capita health care costs are kept down and better overall health care outcomes are achieved:
• Universal health care coverage, but not necessarily a single payer system.
• More emphasis on primary care and preventive health service.
• A greater percentage of gross domestic product devoted to social services and behavioral health.
I propose some practical prescriptions for curing our untenable health care cost problem:
1. Health care organizations must invest in population health management programs, including primary and preventive medicine services, care management, and population health data analytics. Johns Hopkins Medicine started investing in primary care and managed care infrastructure more than 20 years ago.
2. Scientific rigor must be applied to health services research, with special emphasis on health disparities, patient safety and quality, and diagnostic error. JHM is pursuing initiatives on each of these.
3. We must do a better job teaching our trainees to choose wisely in terms of where to treat patients, as well as in the use of technology and drugs. JHM has begun to do this in earnest.
4. We must work methodically to eliminate waste—administratively, operationally and clinically. Here, we can also improve.
5. We must allocate more resources for behavioral health challenges, with particular focus on the opioid crisis. Although JHM is doing its fair share, state and federal governments must do more.
6. We must invest in technology that improves clinical and scientific productivity while enhancing the clinical practice and laboratory work environments so that we don’t lose the joy in medicine. JHM has considerable work to do in this area.
7. As JHM is now doing in a methodical fashion, we must parlay scientific advances into more precision medicine centers of excellence. That way we’ll better understand which patients with a particular diagnosis will respond best to a specific drug or care regimen.
8. We must better align the interests of providers and insurers so that patients can be protected from the crossfire. JHM’s academically driven, integrated delivery and finance system shows real promise on this front.
9. Finally, as difficult as it may be, we must move toward universal coverage in this country—even though, realistically, that may not be in the cards anytime soon.
On graduation day, I reminded the new physicians, Ph.D.s and masters that Sir William Osler, Johns Hopkins’ founding physician-in-chief, regarded medicine and science as a public trust. So should they. However, Osler also believed in not taking himself too seriously. It’s OK, I told them, to have fun. By doing so, they’ll become better physicians and scientists—and help preserve the joy in medicine.