The problems of high costs, poor access, and bad outcomes in American health care are well-recognized, but efforts to address them through policy interventions have had limited success.

In this Public Health Grand Rounds, Martin F Shapiro, MD, PhD, MPH, Professor of Medicine at Weill Cornell Medical College, will discuss three phenomena that create an environment in which all of the groups of actors in health care inhibit needed changes because they feel that they have too much at stake in the current system: the commodification of health care, education, and science; consciousness (values, attitudes, expectations, perceived needs); and problematic communication.

Achieving needed changes requires that we confront these phenomena to be able to create the health system we need.