president

President Barak Obama
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500

   Dear President Obama,

   It is with great honor and purpose that we write this letter to you. As a professional couple involved in healthcare delivery over the past three decades, we have observed the constantly changing landscape that Americans have called "the healthcare delivery system". Your speech to Congress the other night was both enlightening and encouraging. If we could take the politics and profitability out of healthcare, we would not be experiencing an $8000.00 plus per capita per year cost for healthcare delivery while achieving outcomes that place us 39th in the world. We believe that if you take care of people, the financials will take care of themselves. Poor quality, high cost and limited accessibility remain a significant hurdle for our healthcare delivery system to overcome.

         Quality healthcare must fulfill the following criteria:

                   Doing the right thing (need),
                   In the right amount (cost),
                   At the right time (when needed),
                   In the right way (appropriate), and
                   Producing the best possible results for the patient (outcome)

   Healthcare stakeholders in many different venues have repeated this over the past several years in many different ways. Why hasn't much changed? What are the critical healthcare delivery issues to be addressed for Americans to receive what they need to be healthy?

   Our healthcare delivery system is a "sick" care system based on acute, sub-acute and chronic disease diagnosis and treatment. The "medical model of healthcare delivery" no longer meets our needs. However, healthcare professionals are forced to continue to provide healthcare services in this manner.

   There remains a substantial problem with transparency, accountability, reliability and accuracy with respects to reporting healthcare outcomes. The system does not allow the point of care to develop reasonable, cost-efficient means of studying what works and then implementing successful processes quickly and effectively to continue to improve care.

   However, we both do not believe that the major problem lies within the formal structure of healthcare delivery. We believe that the problem is more of an issue within the informal delivery of healthcare in this country. Population and public health issues have changed from infectious disease to chronic disease yet we fail to prevent disease.Prevention of disease is critical to solving many of our healthcare delivery issues. We must establish a national, regional, state and local system of healthcare that focuses on educating our population in four main areas: health promotion, health literacy, safety and environmental awareness. A grass roots effort to train volunteers to serve as lay health promoters is critical to the success of this initiative. Many small and fragmented programs have approached this idea over the past several years around the country. Unfortunately, due to the way our healthcare delivery system works, there is no cohesive effort to bring this concept to the awareness of all Americans. Our community centers, barbershops, and places of worship are just a few of the venues where these lay health promoter programs have been started and studied.

   We would like to propose a national program coordinated through our national, state and local public health system to establish a national lay health promoter program with a standardized training and certification program covering the four major content areas previously mentioned. Developing a structure, process and outcome format should help us report formally to all Americans what works and what does not. The advantages of providing healthcare in this manner far outweigh any disadvantages. Quality, cost and access would be addressed. The savings realized by moving much of our healthcare delivery to lower cost venues would be incredible. Prevention would become our national priority. Unnecessary visits to emergency rooms and coordination of care with patient's medical homes and their primary care physicians would be a significant outcome to measure.

   This proposal is a long-term solution to a long-term problem. It crosses all socioeconomic classes and demographic groups. The better educated our populace becomes about the basics of health and wellness; the better it is for our country with respects to cost and outcomes.

   On a more personal note, I have recently relocated from Pittsburgh, Pennsylvania to Gainesville, Florida to help save a rural hospital (Nature Coast Regional Hospital in Williston, Florida) from closing its doors on the community it serves. Organizing a comprehensive medical home for patients by coordinating their care from the hospital to the health center is our mission. This is what the national healthcare agenda is focusing on now. Our roadblocks are many. Overwhelming poverty, high unemployment, illiteracy and a general lack of health and wellness continues to impede our progress as we see the third and fourth generations raised within entitlement programs present for healthcare services. This is where a grassroots effort is needed to stop the cycle!

   Mr. President, for those of us practicing medicine in the trenches, we need to have our voices heard loud and clear. Please take note of our proposal for a new beginning.

Respectfully,

Dale J. Block, MD

Ellen G. Block