Stakeholders in the U.S. Healthcare System: A Possible Future Public Deposited

In 2014, Don Berwick, MD, MPP, compared his months on the Massachusetts Gubernatorial campaign trail with Marco Polo’s travels to the legendary city of Xanadu. Instead of finding silk and spaghetti, Berwick found pockets of poverty, despair, and a health system that was penny wise and pound foolish. He also found hope in community programs geared toward breaking the inexorable downward spiral faced by many Americans. Halfway through his presentation, Berwick said, “You can see what it (healthcare savings) might look like. I saw it last week on a trip to Oregon.” Berwick’s casual comment opens a path to the discovery of social determinants of health, the role of trauma in disease and healthcare utilization, and the difference between health care and sick care. This paper is a thought experiment, set in a fictional tri-county area named for historical, utopian communities, to determine what you might see if a CCO “somewhere down I-5” could bring together a variety of proven, innovative approaches to the problems that plague the American medical system, costing trillions of dollars, and doing very little to improve health.

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