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The Conference Board Review® Article
The Healthcare Crisis — Solved?
In an interview in our July/August issue, Harvard management guru Michael Porter discussed his new book, Redefining Health Care: Creating Value-Based Competition on Results — co-written with Elizabeth Teisberg of the University of Virginia's Darden School of Business — and the book's competition-based proposals for tackling America's healthcare calamity. We asked several healthcare authorities to evaluate and comment on those proposals. The original interview is available on our website.
By A.J. Vogl
Rashi Fein:
One wishes that Michael Porter's claim that he has discovered The Answer to what ails American health care were true. Regrettably, that is not the case. This should not come as a surprise since, in actuality, there is no Answer. Indeed, why should there be? A functioning health system must meet multiple goals (including producing what Porter calls "value") and do so even as society wants to distribute health care in a manner that permits everyone to translate individual "needs" into economic "demand." The U.S. healthcare system is sick, and the illness involves multiple conditions that call for multiple remedies.
One can welcome Porter's emphasis on transparency, on "value," on "cycle of care," on outcome measures, on information systems that (some) patients would find useful. The fact that these are not especially new concepts in the health field and that many parts of the healthcare system are adopting the thought patterns he articulates clearly and with vigor does not negate the contribution that one more voice, especially Michael Porter's voice, may make. Thus, I hope that many will read and heed this interview and his and Elizabeth Teisberg's book.
Yet I wish that he told us more about how we get from here to there. Telling us that we will get there if "each individual actor could take steps to make things better, even if nobody else changed" has a sermon-like ring to it. As with many sermons, the congregants feel better for having been chastised even as they continue behaving as they had. Relying on "change" without a spelling out of incentives that would spur change, of the forces arrayed against change because the status quo serves them well and how to deal with those forces, without even a passing reference to public action in a system in which government is an extraordinarily large payer through Medicare and Medicaid, leaves the reader incomplete and disappointed.
Porter offers us his diagnosis and his therapy. I wish there were more nuance, more variables, and multiple answers to multiple problems. Yet even if one thinks Porter has got it right, one can feel frustrated that he doesn't tell us how to get the patient to take the medicine.
Rashi Fein is professor of medical economics, emeritus, at Harvard Medical School and co-author of, most recently, The Health Care Mess: How We Got Into It and What It Will Take to Get Out.
Comments? Write a letter to the editor.
Return to the September/October 2006 The Conference Board Review® issue.
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