Vital Directions and National Will

• Autores: Donald M. Berwick
• Localización: JAMA: the journal of the American Medical Association, ISSN 0098-7484, Vol. 317, Nº. 14, 2017, págs. 1420-1421
• Idioma: inglés
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• Resumen

  • If the United States had undertaken road building or space exploration in the same way it is chasing health system reform, there would be neither an interstate highway system nor footprints on the moon. The successes depended on clear, bold, shared aims; strong investments in technical mastery; continuity of purpose over time; and continual learning at a large scale—not to mention considerable celebration. Health care reform has had none of these.

    The reasons for the difference are many. The National Aeronautics and Space Administration (NASA) undoubtedly faced political headwinds, but they were not gale force, because NASA was not dealing with $3 trillion of the US economy, a panoply of stakeholders with financial interests in the status quo of health care, professional fragmentation, or a viciously complicated legacy payment system designed by no one at all. In addition, NASA’s tools—such as rockets and orbital mathematics—were fit for purpose, or could be made so. There was no prior moon shot to be displaced.