I’ve thought a lot about how to re-start this blog. I finally figure out that there would never be “enough time to do it right” or “a continuous stream of fabulous ideas” or “the perfect schedule to attend to it regularly.” I wanted to re-launch with something witty and had lots of ideas bounce around, none of which made it out of my head and onto the website. So I decided to just start without any grand plan.

I attended the Institute for Healthcare Improvement National Forum last month and heard the keynote delivered by John Kitzhaber MD the former Governor of Oregon. He spoke about healthcare reform and laid out a plan to make it real. I really loved the way he framed healthcare costs. He said that 9% of Federal tax dollars are spent on healthcare today and by the year 2025 it could be up to 32% based on current trends. That amounts to over 60 trillion dollars. I don’t know about you but it’s hard for my right brain dominant head to understand a trillion? He said, “A million seconds ago it was the beginning of last week. A billion seconds ago Nixon was just leaving the White House. A trillion seconds ago it was 30 thousand BC.” When you think of 60 trillion and realize that up to 50% of healthcare dollars are waste….providing no benefit to patients it makes the bailout of the auto industry and Wall Street seem like a pittance.

One of the things he said that’s been rattling around in my brain is, “Our system is designed to provide Healthcare not health.” I wonder what would happen to the economics of healthcare if reimbursement were aligned with prevention of disease and self management support for people with chronic disease rather than big dollars for big heroic procedures near the end of life?