How to change the future

(Last in a series)
GREATER Boston's assets, from its deep pools of talent and capital to the great center city and picturesque towns, are world renowned. So why rock the boat, spend time, money, or intellectual capital on risky new undertakings? We caught a whispered undertone in many interviews: "Aren't we already the `hub' of what counts?" But there's a fatal flaw in defensive strategy. Boston has seen its advantages wither before. If innovation is its critical resource, momentum should be its mantra.

ADVERTISEMENT

We nominate three bold maneuvers:

Forge a new American healthcare system. Few places on earth compete with Greater Boston's distinguished constellation of teaching hospitals, schools of public health, and profusion of research-related clinics. A third of FDA-approved drugs originate with Boston-area corporations. In biosciences, Boston's lead over other regions is so wide that Harvard Business School professor Michael Porter confidently told us: This is "one lead we won't lose."

But there are risks. Expensive to run, teaching hospitals face growing crises in recruiting nurses and lab technicians in a high-cost local economy. Single-purpose private clinics are nipping at their heels. Massachusetts' extraordinary multi-billion dollar share of federal medical research outlays, already declining, may well become a political target.

Meanwhile, American healthcare is at a crisis point, its costs inflating wildly, unnecessary medical deaths at 100,000-plus a year, millions of Americans without health insurance. Hospitals are engaged in an arms race for advanced equipment and superior surgeons. Pharmaceutical firms are generating costs faster than cures. Inflating Medicaid costs are on a path to consume the entire Massachusetts state budget.

Are either Congress or state legislatures likely to solve the crisis? We think not. Some region of the country -- some citistate -- could lead the nation by redesigning today's dysfunctional system so that the quality of healthcare actually improves, costs stop their giddy escalation, and all citizens get basic care. Could Boston be that pioneer? We believe so.

The ingredients for a breakthrough may be at hand -- the systematic data collection efforts of the Massachusetts Health Quality Partners, models like the Longwood Medical Area's 19-institution collaborative, and the growing interest in radical system reinvention in the New England Health Care Institute.

But Boston's hospital administrators will have to squelch their historic turf wars and jealousies. The goal -- tough but not impossible -- must be a region-wide approach that stops medicalizing most conditions (got a problem, here's a surgery or a pill). Instead, the region's medical establishment has to shift course to make prevention techniques and smarter life styles a big part of its formula.

Sounds tough? Cracking the human genome did too. If any American region has the range and depth for 21st-century medical system reform, it's Boston.   Continued...