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A Prescription for Our Nation's Ailing Health Care System

Karen Davis



The last time health care reform was on the national agenda, a fictional couple named Harry and Louise helped ensure its demise with the refrain, "There has to be a better way."

The couple, who appeared in advertisements sponsored by the Health Insurance Association of America, decried what some viewed as the bureaucratic nature of the 1993 health care reform proposal and urged viewers to contact their congressional representatives to vote against it. The ads put a human face on the issue for millions of Americans.

Nearly 15 years later, the U.S. health care system—despite some incremental reforms—is, if anything, worse off.

Today, Harry and Louise might very well be among the 47 million uninsured Americans who are struggling to pay for needed medical care, possibly bankrupting themselves in the process. Or they might be one of millions of Americans unable to obtain the coordinated, quality care enjoyed by residents of so many other countries and instead experiencing lost medical records, redundant tests, and poor oversight of chronic health conditions.

Or they might already be victims of one of the thousands of medical errors that occur in the United States every year—most of which would be preventable with better information systems and more reliable care processes.

One thing is for certain: On the eve of a presidential election in which health care promises to play a prominent role, Harry and Louise, as well as others like them, still do not have access to a high performance health system.

To understand what this means for Americans and how our system could be so much better, let us consider another fictional couple: Angela and Martin. Only this time, let's imagine the two of them not in today's health care system but in a world somewhere in the near future, one in which the United States has embraced and implemented a high performance health system. Yes, Harry and Louise—there is a better way. It is called a high performance health system, and this is what it looks like.

Download the PDF to read the complete essay.

Publication Details



K. Davis, A Prescription for Our Nation's Ailing Health Care System, The Commonwealth Fund, January 2008.