Imagine for a moment a fantasy health care system that acted in its own enlightened self-interest and for the benefit of the individuals it served and the health of the populations they composed. Describing such a system would call for a different language. Out would golofty talk of rights and entitlements and endless argument about who pays for what and how much. In would come one down-to-earth question: What is it that we are buying?

It is a fantasy because of the gap between what we know and what we do, between the output of biomedical discovery and its translation into clinical practice and better outcomes. This gap leads to crippling inefficiency in a delivery system beseiged by unlimited demand and insistent expectations, and to hugh variability in cost and quality. Political attempts to control, regulate and guarantee access miss the point and have not helped to close the gap.

Begin Again Now explains how to close the gap and keep it closed. While history bequeaths no simple policy parallels to the future, Abraham Flexner's reforms of a century ago still teach by analogy. Begin Again Now identifies the components of a new system of service, a new way of doing medicine and helath-care service innovation that speaks to today's future as powerfully as Flexner's ideas about the union of science and medicine spoke to yesterday's. And it proposes how to institutionalize disruptive reform - the enduring lesson in Flexner's heritage - and achieve impact transcending the resources invested.

What to do is no secret. Doing it is within our reach. Why not begin again, now?

About the Author

Robert E. Wright (Abington, PA) is a Clinical Associate Professor of Economics at New York University's Stern School of Business. He is the coauthor, with George David Smith, of Mutually Beneficial (0-8147-9397-5), among other books. Timothy C. Jacobson (Staunton, VA) is an author and editor who founded "Chicago Times" magazine.

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