What will it take to harness the opportunities that new patterns of health investment could yield? Even to those with grand ambitions, the obstacles can seem insurmountable, the resources too limited, and our collective will too tentative. And what’s worse: skepticism itself can impede any effort to depart from the status quo.
Very often we tend to fear the financial implications of any new direction as a way of protecting today’s bottom line. And there is a long list of similarly deeply-seated conditions that can stand in the way of progress, such as: organizational and financial fragmentation; entrenched partisan division and gridlock; fierce competition that pushes health care professionals toward expensive and often excessive services; historical disinvestment in the social and economic conditions that support equal health for all; as well as a steady erosion of the democratic principles and civic muscle that might allow us to collectively manage our common health systems in ways that better fulfill our values and priorities. After more than a century spent building a healthcare industry focused mainly on individual services and the power of particular institutions, the very notion of health as a common concern or a cause for public work can seem very foreign.
Nevertheless, progress is possible. No matter how bleak things may seem, we can foster the conditions that will help build a more inclusive and interdependent health economy. Some steps in that direction might be to:
One of our founding ReThinkers, Elinor Ostrom, won a Nobel Prize in Economics by demonstrating that it is possible to sustain precious resources—even in sharply contested circumstances—through an inclusive commitment to shared stewardship. She showed that when it comes to governing common resources, it is often better to devise a set of widely shared democratic practices, rather than seek solutions from a strong state or an unchecked market.
These and other hard-won insights from veteran changemakers provide some of the most reliable guidelines for navigating confidently within a health system that is so hotly contested and constantly in flux.
In the next section, we consider how several hundred multi-sector partnerships across the country have been framing and financing their work.