I just returned from the sun-drenched Rockies where the 2009 Aspen Health Forum, hosted by the Aspen Institute and TIME magazine, was held. The clarity of mind induced by the fresh mountain air (or perhaps the neutral venue and balanced conversations) crystallized my vision for meaningful health care reform, which I shared with TIME magazine managing editor Rick Stengel as we answered questions from his readers about The Dr. Oz Show and what role it might play in the larger framework of health in America.

Part of the challenge we face is that all eyes are focused on healthcare finance arguments in Washington, but the real action is taking place in our homes across this great land. We cannot have a wealthy country without being a healthy country, but healthcare finance solutions by themselves do not help us care for our health. An insurance card is correlated with, but does not guarantee a clean bill of health.

I am a practicing heart surgeon, but I also attended Wharton Business School and have joined Oprah Winfrey on TV and radio, so I have collected many insights from wise souls knowledgeable about this nation's battle for health. My prescription for health starts with the fundamental reality that no healthcare finance solution will work without arresting the increasing costs of the healthcare business. I know this is painful news for many, but doctors are used to giving bad news and still maintaining the respect of our patients, so please keep reading.

To control costs without rationing care, we need to improve the quality of the services we buy for our money. Economists and the few remaining car salesmen would agree that this translates to better value. We have two principal options. First, we need to eliminate the 20 percent of services offered that are wasteful or harmful. For example, if you live in Texas, California and Florida, your states offer some of the most expensive healthcare in the U.S. without providing measurable benefits. Their healthcare offers limited value primarily because some in the medical community lost their way.

Doctors need to act like professionals and police our own for doing unnecessary tests and procedures but we also need smart patients to insist on second opinions that will change their diagnosis or therapy in a third of all cases. You heard right, over 30 percent of patients will get materially different recommendations from a second opinion. Many of you are bashful about pushing to see another doctor, but when you get doctors to speak with each other about your case, they teach each other and every subsequent patient that sees your doctor will benefit because you were brave enough to drive quality into the system.

What does "prevention" really mean?


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