Sublime

At the Veterans Health Administration, Ken Kizer, appointed by Bill Clinton in 1994, inherited an antiquated, inefficient health-care system. The VA faced changes in its client population, the competitive healthcare environment, and modalities for delivering care.2 In just five years, Kizer instituted an electronic medical record system, made struc

Over the past several years, in an attempt to make healthcare more efficient, various “process improvements” (excessive documentation, regulations, and a variety of other hoops and ladders) have replaced time spent with patients.

Third and finally, it’s urgent that we go beyond utilitarian arguments to continue to stake moral claims for improving access to quality health care for all. Increased efficiency and lower costs, though important, are not the alpha and the omega of health care improvement, and they are still less of a factor in the improvement of health itself. The

As chronic disease came to replace communicable diseases atop the list of medicine’s priorities, realms of an individual’s life that had heretofore been considered private and therefore forbidden from physician inquiry, such as diet or marital relationships, came to be seen as important determinants of health.

Mitch Katz directs the Los Angeles County Department of Health Services, the second-largest county health care system in the country. He described to me how economic incentives can stack up against upstream care. “Because there’s been little money toward prevention, there’s no payer or mechanism for prevention research like there is for medical res