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Health Care is More Than Medical Care

Wednesday, August 27, 2014


Jonathan Ater

Jonathan Ater

When we use the term “health care” in conversation, the assumption is often that we are talking about medical care – that is, allopathic or osteopathic medicine delivered in a physician’s office or hospital. The terms are not synonymous. This definitional confusion affects much of our public discourse about health policy in this country.

Over the last 20 years, I’ve had the privilege of serving four Oregon governors as chair or vice chair of several public bodies that have addressed health care and health policy. Health care is not just medical care. It is about caring for each of us – and all of us – inside and outside the medical system. Our challenge, as a mature society, is to create and maintain a society of healthy individuals – in every sense of the word healthy.  

America’s population health statistics are far below those of many other economically developed countries (and even some third world countries), while our per capita health care spending is far higher than any other country.  We fall behind in many categories, including life expectancy, infant mortality, and chronic conditions such as diabetes and obesity.

Oregon’s health statistics are among the worst in America.  

In spite of the skill of individual care providers, the stories of heroic medical events, and the strength of American research and technology, our current system has failed literally millions of individuals, and it has thus failed all of us. We are poorer than we should be because we do not have a working health care system.

Simply put, our country spends too much on medical care and too little on health care.  

Changing the industrial model

Health reform is not just about changing how we pay for medical care.That is important, but it is not sufficient. We need to change the industrial model, as well as the financial model.

Our medical care is often technically competent, but frequently overtreats or fails to treat. It is inefficient and very expensive. The medical system does not communicate well within itself or with its customers. It operates in silos and largely independently from other health care and service providers. It does not reach out. It reacts to problems that appear on its doorsteps.

The medical system is not built or operated on a wellness model. It is not an efficient or sufficient way to meet the nonmedical needs of its customers: for example, the home support necessary to help new mothers breastfeed and nurture their infants or help elderly folks with ordinary living activities which keep them strong and well.  

When we improve health care, not just medical care, we will hit two home runs in the same inning: we will improve health outcomes and – believe it or not – we will lower costs. America spends almost 20 percent of our GDP on what is loosely called health care, but which is primarily medical care. We spend huge additional sums on the social costs that are the consequence of a failed health care system. Investing in smart health care can have a huge financial payback.  

In the last two years, Oregon has begun to experiment with a new approach to health care, called Coordinated Care Organizations or CCOs.  Think of this as a form of industrial revolution, in which we are creating new ways of building and supporting healthy individuals and a healthy community.  

CCOs engines of collaboration

The idea is that CCOs are engines of collaboration and coordination among enterprises and their workers, which have traditionally worked independently:  medicine, dental, mental health, naturopathy, chiropractic, public health, and social service organizations. CCOs are community based, with ordinary folks having a real voice.

Initially, CCOs have been formed to help care for Oregon’s poorest folks, those who are on the Oregon Health Plan.  

But, this new industrial model is not something just for poor people.This model has the potential to reform and improve the way we all receive health care.   

CCOs are about creating health care which is truly accessible to individuals and responsive to each individual’s needs. They are about helping folks stay well, stay home, stay fed, and stay alive. They are about wellness, not sickness.

There is every reason to believe that Oregon can create a world class health care system, one built on the talents and good will of many individual organizations and caregivers working together. We don’t have to settle for Third World results. We can create health care in the true sense of that word.

We will all be better off when we do.

Jonathan Ater is senior partner of Ater Wynne LLP. He counsels leaders in health care and other enterprises. He served as Chair of the Oregon Commission on Children and Families, Co-Chair of the 2004 Mental Health Task Force, and Vice Chair of both the Oregon Health Policy Commission and the Oregon Health Fund Board. He served on the Board of Higher Education. He is a graduate of Yale University and the Yale Law School.


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