I was reminded recently by a great teacher and CoH mentor that “shouting louder than the person across the table” rarely broadens perspective. And so I wonder whether President Obama, the administration, or anyone at all now debating the nation’s health care solution can hear an idea that doesn’t fit the prevailing health care frame.

In a 6,000-word interview by David Leonhardt (The New York Times Magazine, May 3), the president talks a lot about health care, but misses the opportunity to mention some fundamentals about health. Filling the gap were Letters linking education and health, and reminding us that most advances in the nation’s health have come from investment in population-based prevention, not individual care:

“…compared with college graduates, people who don’t finish high school are more than three times as likely in some states to have less than very good health. Their rates of diabetes and heart disease are five times higher than those of people whose health is very good or excellent… Improving education can improve America’s health, which in turn can help our nation lower health care costs, which in turn can help our economy. Education, health and the economy are all linked. Policy makers should develop a unified approach to addressing these issues.” – James S. Marks

“(Improving) the health of as many individuals as possible, minimizing the need and demand for critical care — have come about as a result of government involvement in what may be called indirect, nonclinical endeavors like healthful air, healthful water, healthful food, safe buildings, healthful waste disposal, large-scale epidemiology and basic scientific research. The extreme diversion of public funds to individual care shifts the public focus from public health to the financial benefit of the individual clinical practitioner, but it would be valuable for the government to consider ‘health care’ in the more general sense of public-health programs.” – David C. Garron

There are plenty of sound approaches, supported by evidence, that will dramatically improve health, and not just health care (some are posted here). Now, how do we crack the frame wide enough to get a new idea on the table?