[Note to the reader: Anything that is in italics and square brackets, such as this note, is addressed to you, personally. Yes, you. Try it on; see if it fits.]

Health care has, right now, the greatest opportunity we have seen in our lifetimes to make a big change, to rebuild itself in a hundred ways to become better and cheaper for everyone—to get cheaper by getting better. We're not talking "bending the cost curve," cutting a few points off the inflation chart. We're not talking a little cheaper, a little less per capita, a few percentage points off the cut of GDP that health care sucks up. We're talking way cheaper. Half the cost. You know, like in normal countries.

We're not talking a little better—skipping a few unnecessary tests, cutting the percentage of surgical infections a few points. No. Don't even think about it. We're talking way better. Save the children, help the people who should know better, nobody dies before their time, no unnecessary suffering. Seriously.

I don't know how high you want to aim but, personally, I think we should aim at least as high as the cutting-edge programs and facilities that are already out there, in the system as it exists today—cutting real health care expenses of real people, even "frequent fliers," by 10, 20, even 30 percent, while making them much healthier. At least. To me, that's a wimpy goal, doing as well as some other people are already doing. Because these programs are just getting off the ground. They're in the first few iterations. The stretch goal, the goal we can take seriously, is to cut real costs by 50 percent, by making people healthier. There is at least that much potential out there.

All the Ways the System Doesn't Work


You want a little convincing? Here's an easy exercise: You know how the system actually works. [Note: Yes, you do. You've been around the block, right?] Pull up an empty notes page on your laptop, iPad, Blackberry, iPhone, whatever, and just start making a list of all the frustrations you can think of, the thousand and one ways that the system does not drive toward the best health at the least cost for the people it serves: the missed handoffs, the wrong person/wrong drug mistakes, the lack of engagement with the patient's life, all that. [Note: My guess? You can come up with a better and longer list than I can. Every person with whom I talk and who actually works in health care has buckets of this stuff for me, every time we talk.]

Now do a little imagination exercise: Go down that list, stop at each item and imagine some way in which the system could eliminate it. Imagine that there were some systemic change that made it nearly impossible to give a person the wrong drug, that meant that everybody got good health coaching, and that nobody ever got an operation that actually wouldn't help them, whatever is the inverse of each frustration on the list. Imagine what each of those changes would mean to the effectiveness and cost of health care.

Now imagine that somebody, somewhere, has done just that. Somebody is solving that problem in ways that can be duplicated where you are. Because that is what I am seeing all across health care, and it's a breathtaking story.

A Word about Systems

Do you know that 32,000 people died in car crashes in the United States in 2010? That's the lowest number since 1949. That's far more impressive than it sounds at first, because people in the United States drove about 10 times as many miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you were 10 times more likely to live through each mile you drove than was your father or grandfather 60 years ago.

Why? Are we better drivers? Nah. Seatbelts, airbags, tougher DUI laws, breathalyzers, graduated licensing for teenagers, anti-lock braking systems, better highway designs, crash barriers, rumble strips, median barriers, steel-belted radial tires that don't blow out, crumple zones, better bumpers…system tweaks that work, that make it 10 times as hard for even a terrible driver to kill either you or himself.

It's the system, not the individuals. We have only started on the thinnest little wedge of that kind of thinking about health care. That kind of thinking will take us way beyond evidence-based medicine to what is coming to be called evidence-based health. Evidence-based medicine does everything necessary to stabilize diabetic-shock patients; it gets their blood sugar under control, gives them the right prescriptions and sends them home. Evidence-based health goes home with the patient, if necessary; it does whatever it takes to find out why he or she was in shock in the first place, to make sure prescriptions are filled, the patient eats better, gets good advice and doesn't end up back in the ER in a month.

The Reform Is Not the Change

The federal health care reform law is a catalyst, an enabler and an accelerator of the change we are going through. It is not the change itself nor the cause of it, because the change is driven by much larger economic and demographic factors, especially by the crushing cost of health care. If the reform law were to go away, the change would not go away.

Here's why the change is actually happening: As all these factors have come together, everybody in the business has come to believe that the usual way of doing business is crumbling under them. Everyone—doctors, hospitals, home health agencies, insurers, employers—is desperate to find a new footing. And no one has found that certain footing yet.

Eight Methods for Screwing This Up

So this is, as the sportscasters say, our game to lose. It's our change to screw up. And we can screw it up, big time. In case you are interested in helping that happen, here are eight ways to go about it:

Pretend it's not there. Denial. A few tweaks. Business as usual. Same-old. Flavor of the week. Hey, it's not my problem. I can squeak through to retirement anyway. [Note: Hello.]

Pretend it's there and we know exactly what it is. We know its address and its measurements, the forms to fill out and the boxes to tick off. It's all execution. Trust me, I've done this before. [Note: Actually, you haven't. Nobody has.]

Fend off risk. Go for the safe choice. Pull up the drawbridge. Hunker down. We can't afford to extend ourselves in this budget cycle. If we try that, it'll just piss off the doctors. Better wait until this whole thing settles out. [Note: Let us know how that works out for you. From here, it looks as though the waters are rising really fast.]

Grab an answer. Download a package. You don't recognize the edge of panic in your voice when you say reassuringly, "This is what works. This is the solution." [Note: When the problem is not simple or static, the solution is not unitary.]

Mistake it for an opportunity for an empire. Build ACOs as regional monopolies to push up our compensation and grab market share. [Note: Consider this. How would your answer change if the question was not "How do we grow the enterprise and make our careers safer?" but instead was (truly now—be brutally honest, at least with yourself), "How do we help the people we serve better? How do we ease the suffering? How can we do that for more people? Cheaper? Earlier?"]

Make it a turf war. Grab territory. Knock out the other guy.

Pretend it's not a turf war, and lose it. Stand by while the other guy eviscerates your hold on the market. [Note: Of course, people are going to treat it like a turf war. When everyone's livelihood is threatened and their value is challenged, that's what they do. That doesn't mean you have to. In some games, the only way to win is not to play.]

Game the system. Figure the angles. Make "What's in it for me? What's in it for us?" the only questions worth asking. [Note: Here's the invitation: Play a bigger game. The author Harriet Rubin said a marvelous thing: "Freedom is a bigger game than power. Power is about what you can control. Freedom is about what you can unleash."]

Consider This

"Since death alone is certain, and the time of death is uncertain, what shall I do?" Yes, I'm quoting somebody. Never mind who. No, don't write it down. Don't Facebook it, Tweet it, stick it in Evernote, e-mail it to someone. In fact, don't even think about it. Don't think it through, generate options, prioritize. Stop. Just sit with it, just for this one moment: "Since death alone is certain, and the time of death is uncertain, what shall I do?"

Whoever you are, however you have defined yourself so far, you have your hands on some portion of this great rambling chaotic sacred Grand Guignol parade we call health care. You have some influence. You can nudge it, poke and prod it, reshape it, help it grow, make new connections, try new skills. Health care is where we bring our suffering and our tricks to defeat suffering.

We can do this. It is as if the sky has opened up, a break has occurred in the pattern; there is an urgency, a swiftness to events, a tide, a moment, a momentum. Let's roll.

Joe Flower is a health care futurist, speaker and founder of Imagine What If, a service of the education firm The Change Project Inc. Flower is also a regular contributor to H&HN Daily and a member of Speakers Express.