Secretary of State Kathleen Sebelius (of Health and Human Services) gave a speech at The Johns Hopkins Medical School (the entrenched specialty mecca and ground zero for the current health care mess that has been almost 100 years in the asking) entitled Moving Academic Medicine Forward. Following are some excerpts:

More than 100 years ago, when Abraham Flexner had to decide which institution to use as his model of medical education, there was little question which it would be. The influence of Johns Hopkins, he wrote, can hardly be overstated. And a century later his words seem truer than ever.

Hopkins has been a leader time and time again: the first major medical school to admit women; the first to use rubber gloves during surgery; the first to develop renal dialysis and CPR. Hopkins helped develop new specialties from neurosurgery and urology to endocrinology and pediatrics.

Over the last couple decades there has been a growing consensus about where we need to move our health care system: toward a focus on prevention and maintaining health, a greater emphasis on primary care, more coordination between providers, greater value for dollars spent, and better use of evidence, leading to continuous improvement.

We’re moving in that direction. But I think it’s clear that we’re not moving fast enough. Though we’ve been talking about these reforms for decades in some cases, our health care system is still marked by uneven quality, unequal access, and runaway costs that put care out of reach for far too many families.

Today I want to talk about a few key areas where I believe we have the greatest potential for progress.

The first area is making prevention a priority. There is a growing body of evidence that people’s behaviors outside the health care system – what we eat, how much we exercise, whether we smoke or not – affect our health even more than the treatments and medicines we get when we visit a doctor.

For doctors, this meant experiences like designing the perfect regimen for your patient with diabetes, only to see them go home to a neighborhood where the lack of healthy food options meant their chances of sticking to that diet were almost zero.

So over the last three years, this Administration launched what is probably the most ambitious effort in our country’s history to help people make healthy choices: funding innovative local programs for reducing chronic disease; new laws to make sure kids get healthy school lunches; and historic legislation to make it harder for tobacco companies to market their products to kids — since we know that every day, 3,800 young people smoke their first cigarette.

Another area we’re focusing on is primary care which is fundamental to helping people stay healthy. Yet we face a dire shortage of providers across the country today. As chronic diseases continue to rise and our population continues to age, the need for primary care providers will only grow.

But we also need academic medicine to further explore the importance of primary care in your research and underscore it in your training. Far too often, especially at our leading teaching hospitals, primary care has been treated like it was less challenging, less important, and a less worthy use of a physician’s skills. We need to change these attitudes, and that starts with our medical schools.

But ultimately, the choice belongs to the next generation of doctors. So, to the medical students here today, I ask you, directly, to consider becoming a primary care physician. If you want to help lead the biggest transformation of medicine in decades, there’s no better place to be.

This is why I support the President’s re-election.

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