Much to learn

I think we all agree that it makes sense to look at the things that have worked for other systmes and try to incorporate them into our own system, instead of re-inventing the wheel every time. However, there is no perfect system, and every country has fundamental differences in the attitudes of the people, the politics, the finances and the social agenda.

Of all the reform ideas, the one I think would be most acceptable and have the highest impact in the US is to have a committee that reviews the cost-benefit and scientific data supporting various treatments (such as the NICE committee in the UK), and have government subsidies for those treatments. We already have a functional system like that, in that Medicare coverage drives the insurance reimbursements for almost all medical services. Furthermore, the US government makes recommendations about acceptable screening practices through the US Preventative Services Task Force and treatement practices through the CDC. However, even these are not without controversy. The USPTSF just published new guidelines on Mammography which have NOT been accepted by the American Cancer Society, the American College of Obstetrics and Gynecology or the American Medical Association, despite being based on the evidence.

The other idea that might work here is to go to a computer based medical record system. The opposition has a clear argument around personal privacy, however our country has been quick to embrace the mobile media, and would quickly realize the benefits of a uniform, easily accessible medical record, much like they have in Taiwan.