Former R.I. health director Michael Fine issues clarion call for health care reform

By G. Wayne Miller
Providence Journal
September 6th, 2018

Family-care physician is eminently qualified to dissect health care in America today and to propose a way forward.

The United States spends more per person for health care than any other country yet has some of the worst health outcomes among the industrialized nations. So if that $3.2 trillion annually overall doesn’t buy something better, where does it go?

To armies of lobbyists, private insurers, Big Pharma pushing unnecessary medications, and hospitals and practices that provide expensive technology-based treatments that might be avoided were primary care emphasized in America — among other players. As Dr. Michael Fine writes in this searing and thoughtfully articulated indictment, “we have a health care services market and not a health care system.” Overall, profit rules.

Others have made a similar point, especially recently with the rancorous debate over the Affordable Care Act, but few have made it as powerfully as Fine — and none, to my knowledge, have proposed as bold and comprehensive a solution as his in “Health Care Revolt.”

A longtime family physician in Scituate, director of the Rhode Island Department of Health from 2011 to 2015, and now chief health strategist for Central Falls and a leader of Blackstone Valley Community Health Care, Fine is eminently qualified to dissect health in America today and to propose a way forward — one he asserts would save $1 trillion or more a year while erasing health disparities and improving the health of everyone. All while restoring Americans’ faith in democracy, which is where the revolt comes in.

The foundational philosophy of the Movement for Health Care in America, as Fine calls it, is that individual health is a function of public health — and that public health, what we as a society should all support, is determined not only by professional care but also, fundamentally, by education, housing, social connections, levels of stress in families and neighborhoods, income, access to healthy foods and other socioeconomic factors.

The movement’s goal would be small primary-care centers in every community linked to larger multi centers, which in turn would be linked to hospitals, should advanced treatment be required — which would be far less frequently, Fine writes, with a proper emphasis on primary care. Fine cites examples of such successful primary-care centers, including Blackstone Valley, where he serves as senior population health and clinical services officer.

Don’t expect politicians or industry executives to lead the charge. As Fine writes, “There is no one, in government or outside of it, who is held accountable to produce the best health outcomes most affordably.” Thus, Fine concludes, the fight to this better future must be championed by clinicians and citizens, through establishment of a national coordinating council with local chapters. The work, Fine concedes, would take years — and might not succeed.
But Fine has faith, citing other great American movements that have succeeded against great odds, starting with the Revolution.

“The health care market won’t change easily,” Fine writes. “Vested interests will fight tooth and nail to keep things as they are. They will lie, cheat, steal and threaten us all with death. [But] nothing will change unless we act up. The likelihood of success is small. But the likelihood of success without trying is zero.”

Whether you work in health care or just want good health, and that covers pretty much everyone, “Health Care Revolt” is a must-read. We deserve better than the expensive and ineffective mess we have now.

— Staff writer G. Wayne Miller covers health for The Journal. He has written four books on medicine: “The Work of Human Hands,” “King of Hearts,” “The Xeno Chronicles” and “Top Brain, Bottom Brain.” Visit him at

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