Students, alumni and community members piled into Dartmouth Hall on Saturday morning to attend a presentation on the complexity of the United States health care system delivered by Dartmouth Center for Health Care Delivery Science Director Al Mulley '70. Mulley emphasized the role ordinary citizens play in changing the health care system both through daily choices regarding their own health and the attention they pay to the health care decisions they make. A reformed health care system should prioritize individuals' "personal preference" in medical decision making, Mulley said.
"If you don't recognize the individual uniqueness of the people who live with the consequences of health care, you inevitably do what?" Mulley, a former member of the Board of Trustees, said. "You give interventions to people who wouldn't choose them while you withhold them from people who would."
The United States spends approximately $2.5 trillion, or 17 percent of its gross domestic product, on health care each year, Mulley said. Despite spending more on health care than any other country in the world, the United States ranks 37th in the World Health Organization's standings on health care system performance.
"More care does not equal better care," he said.
Mulley began his lecture by alluding to the Tragedy of the Commons, a dilemma that emerges when multiple individuals demand a share of limited resources even though they know that their actions will deplete the resource and that doing so will harm their long-term interests. Mulley applied this economic principle to health care by explaining that a high demand for investment in too many types of care ultimately hinders the health care system's efficiency.
"Whatever capacity you build into health care will get used," he said. "So where do you invest?"
Despite the urgent need for a solution to the nation's health care woes, agreeing on a plan for reform is difficult due to "the fog of health care," Mulley said, referring to the high level of disagreement and uncertainty concerning the issues that future reform should address.
Health care reformers' most important task is to ensure that every patient receives no less than the care they need and no more than the care they want, according to Mulley. He advocated the principle of "shared decision making" as the most effective solution to the nation's health care problems.
"No decision about health and health care should be made in the face of avoidable ignorance," he said.
Lack of communication and poor knowledge management among doctors directly contribute to the inefficiency of the current health care system, according to Mulley.
"I am convinced that people are getting far more care than they would choose if they were well informed," he said.
The level and frequency of care that patients receive is largely determined by geographic location, according to Mulley. The significantly higher incidence of back surgeries on the West Coast compared to the East Coast is one example of such discrepancies and likely does not reflect a higher number of individuals with back problems, he said.
"The care you receive can depend more on where you live and who you see to get that care than who you are and what you care about," Mulley said.
Zachary Myslinski '15 said he attended Mulley's lecture because he is interested in health care reform since the issue is unlikely to solve itself in the near future.
"I thought it was a really interesting presentation," Myslinkski said. "He brought to light many of the uncertainties related to health care."
Rather than presenting a "specific solution" to the plethora of problems surrounding the country's care system, Mulley offered listeners "a set of principles to follow in the future," Myslinski said.
The lecture, which was sponsored by the Office of Alumni Relations, is the fourth in a five-part Fall 2011 Faculty Chalk Talk series geared toward furthering the education of College alumni.
