CARE EVOLUTION

A report on the complex social and economic issues that are hindering significant patient health care reforms.

Physician and former chief medical officer for Centria Healthcare Merahn’s collection of insightful essays focuses on his view that improvements to health care networks should be a “social imperative” in order to sustain educational and economic progress and avoid systemic inequities. The source of Merahn’s frustration stems from inaction from decision-makers and medical professionals to embrace patient-focused methods of care delivery. He sees health care as a critical necessity—one that’s battered by the forces of economic instability, racial injustice, unconscious bias, politics, and free market capitalist dynamics. Merahn’s research discovered many health care professionals who felt disconnected from their peers and lacking strategies to repair the devaluation of their occupation. The author takes a broad view of his subject, astutely examining the history of American health care and how it’s been incrementally destabilized by “those with less selfless and less generous agendas”; he also addresses how it’s been defined by revenue economics rather than by a philosophy of delivering quality communitywide care. The author writes that although the Covid-19 pandemic has successfully and swiftly mobilized crisis teams across the globe and, in most cases, amply supplied them with the resources they need, it’s also exposed a glaring lack of equitable access to care due in part to systemic racism. He notes that the crisis has also alarmingly revealed a distinct population with “deficient scientific literacy.”

Driven by what he perceives to be glaring systemic inadequacies, Merahn intelligently outlines an evolutionary plan that includes fundamental improvements in clinicians’ financial stability, an organizational restructuring of the care delivery system, and a revised vision of the kind of coverage and support that the American system should be providing. The author leaves little room for doubt that quality health care is urgently needed by everyone and that the system’s goals have, over time, become derailed by the desire for profit and are in need of a remedy that isn’t solely based on “how we pay for care" and is "more about how we plan for care.” Merahn advocates for increased human connection and noncategorical approaches to illness that, in his view, would “transcend diagnoses and acknowledge the power of emotion in influencing interactions in relationships.” Improved attention to patient dignity, integrity, and privacy are also key to this restructuring, he notes. The major thrust of his argument is based on the belief that health care should be free of doubt and confusion; because it’s become mired in these states, there needs to be a redesign and focused return to a “whole-person” frame of mind. Although the author’s medical industry rhetoric and densely rationalized arguments may sometimes be difficult for readers outside of clinical settings to grasp, his impassioned demands for change are unwaveringly convincing. Merahn’s persuasive call for action advocates for no less than an overhaul—one that redirects attention away from “networks of self-interest embedded throughout the healthcare ecosystem.”

An intensive, mindful critique of modern health care that confronts its flaws and proposes solutions.