Overview: the next step

If we are going to reform our healthcare system, we will have to start by providing access to basic care for everyone. This can be done through embracing a strategy that is built around integrated healthcare delivery systems. Payment should be via a universal tax for the basic plan, and there should be ways in which to pursue options beyond the basic plan, to be paid for by individuals. What is provided by way of care will need to be evaluated through a central technology assessment institute. The system will have to slow the rate of growth of spending in an intelligent way, not using price controls, caps, or repressive methodologies. The trick will be to still preserve a certain amount of freedom and flexibility, and include the capacity for change. There will have to be a significant reorientation of what has been our traditional approach to malpractice. Through the course of this symposium there has not been a great deal to be positive about. There are many physicians today who are well described by the English poet A. E. Housman's line, "A stranger and afraid in a world I never made." Change is inevitable; it is here and more is coming. The great medical historian Henry Sigerist noted that: "The physician's position in society, the task assigned to him, and the rules of conduct imposed on him changed in every period. They were determined primarily by the social and economic structure of society and by the technical and scientific means available to medicine at the time."(ABSTRACT TRUNCATED AT 250 WORDS)