Healthcare Reform　　During the past two decades, all of the industrialized nations have enacted some form of healthcare reform. America is no exception. Just a few years ago, the U. S. was consumed by a vigorous public debate about healthcare. In the end, the debate reaffirmed that the U. S. would retain its essentially market-based system. Instead of reform imposed from the top down, 3 the American healthcare system underwent some rather profound self-reform, driven by powerful market forces. The market—not the government—managed to wring inflation out of the private healthcare market. 4　　Today, it appears that U.S. healthcare costs are again on the rise. At the same time, American patients—like patients elsewhere—are becoming more vocal5 about the restrictions many face in their healthcare plans. Talk of government-led reform is once again in the air. 6　　We must think twice, though, before embarking on “reform” if that means imposing further restrictions on our healthcare markets. The more sensible course is to introduce policies that make the market work better—that is, to the advantage of consumers. I base this argument on our company’s decades of experience in healthcare systems around the world, which has given us a unique global perspective on the right and wrong way to reform healthcare. The wrong way is to impose layer after layer of regulation and restrictions. We have seen this approach tried in many countries, and we have always see it fail—fail to hold down costs, and fail to provide the best quality care. Medicine is changing at so rapid a pace that no government agency or expert commission can keep up with it. Only an open, informed and competitive market can do that. This lesson holds true for the U. S., and for all countries contemplating healthcare reform. Free markets do what governments mean to do—but can’t.　　The right approach10 is to foster a flexible, market-based system in which consumers have rights, responsibilities, and choices. Healthcare systems do not work if patients are treated as passive recipients of services: 11 they do work if consumers are well-informed about quality, costs, and new treatments, and are free to act responsibly on that knowledge.　　Of course, reform should never be driven purely by cost considerations. Instead, we ought to devise new ways of funding healthcare that will make it possible for all patients to afford the best care. Ideally, these new approaches would not only reward individuals and families but also encourage innovation, which can make healthcare systems more efficient, more productive, and ultimately of greater value for patients.　　The path we choose will have enormous implications for all of us. We are in a golden age of science, and no field of scientific inquiry holds more promise than that of biomedicine. 13 Not only can we look forward to the discovery of cures for chronic and acute disease, but also to the development of enabling therapies that can help people enjoy more rewarding and productive lives.14 New drugs are already helping people who would once have been disabled by arthritis or cardiovascular disease stay active and mobile.15 More effective anti-depressants and anti-psychotics are beginning to relieve the crippling illness of the mind, allowing sufferers to function normally and happily in society. The promise is quite simply—one of longer, healthier lives. 16　　What is at issue are the pace and breadth of discovery, and how quickly we can make the benefits of our knowledge available to the patients who need them.　　Therefore, the policy environment the biomedical industry will face in the next century may make or break the next wave of biomedical breakthroughs. 17 Will that environment include protection for intellectual property, freedom for the market to determine price, and support for a robust science base? 18 Will healthcare systems nurture innovation, or remove incentives for discovery? Will they give consumers information and options, or impose stringent rules and regulations that limit access and choice? For the U. S., as for the rest of the world, the healthcare debate is by no means over. And for all of us, the stakes are higher than ever.

发布日期：2021-08-15

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