The Daily Beast: Paul Farmer—The Big Idea On Health Care

The charismatic doctor and social activist, known for his work in Haiti and co-founding the organization Partners in Health, talks about why the American health-care system is not working, and what advice he has for the new crop of college graduates entering the real world. His commencement speeches have been collected in the new book To Repair the World.

What is your big idea to impart on college graduates?

The big idea that I underline for medical students would be different from, but related to, a big idea I would share with college graduates. Let me give it a try. It may not sound like a big-enough idea.

I look at American medicine, and I look at how much money we are investing in health care—more than any other country in the world. And you see some of the wonderful possibilities that come out of it, when you have good research linked to care delivery. I would even mention the Boston Marathon bombing. There’s a reason that no one who was injured and made it to a hospital died—because we have really good hospitals in that city, as much as any city. I work in one of them, the Brigham. It is a pleasure to be in a hospital where there are thousands of competent, compassionate people working together for people who are sick or injured.

At the same time, the American health-care system does not perform as well, when you start looking at community-based care, for example, of chronic disease. When you start looking at people with multiple illnesses at once, which you see very often among the poor, and among the elderly as well, then our system doesn’t work well at all. So the big idea that I would give to graduates of medical schools and nursing schools is that we can only have real impact, and the best impact, when we work in teams. And those teams have to reach from hospitals and clinics, to communities. And that's where I hope American medicine is going. The big idea, in that case, is we need to learn how to work with community health workers in the United States, just like we do in Haiti, Rwanda, Malawi, Lesotho.

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