I have been struck by how a Nation’s Health Care delivery and payment system defines what can and cannot be covered under insurance (regardless of the needs of the “covered lives”), what will and will not be paid for (regardless of how effective or needed a service is to the patient) , and how both of these shape how an Alzheimer’s Association/Society evolves into an organization serving the needs of caregivers (most everyone else in the world refers to them as carers), the interests of researchers, and the needs/wants of people living with a diagnosis of dementia, probably of this or that type - but most of the Alzheimer’s type.  

Some, mostly opponents of health care reform, keep claiming the U.S. has the best health care in the world. Measure the effectiveness of our system by any one of 10-20 commonly used measures of effectiveness and you will discover we do not as a country have the best health care in the world, far from it. One area we do lead the world in is the cost of our health care. We are clearly, far and away the most costly health care delivery system in the world. We’re number one - but only when it comes to how much we pay - not how effective it is. 

We clearly do not lead the world in how we are responding to the tsunami of dementia sweeping across the globe. England now has an official, detailed, and funded (at least for now) strategy on how it will respond to the Tsunami (so does Australia, so does the European Union). I suspect there are other nations who are completing their national conversations on how to deal with this crisis, and preparing to implement a plan. Not us!  

What makes other countries move swifter, surer, and better funded than us? Leadership! And where does that Leadership come from - the Nationals Alzheimer’s Association/Society. Our present patch work of insurance, medicade, churches, and the generosity of rich people doesn’t make it any easier for leaders rise up to lead. But I have yet to come across a National Alzheimer’s Organization plagued for so long by so many changes in management, changes in direction, changes in emphasis, changes in staff, and changes in leaders. I have yet to find a National Alzheimer’s Organization that actively keeps people with dementia from assuming positions of direct influence in its budgeting, research, program initiation, and management (both day to day and on a Board of Directors level). I am sure they are out there. I just haven’t run across any, yet.  

It’s time for a National Conversation on Dementia. It’s time for someone to champion that conversation. It’s time for all of us to first decide what is THE RIGHT THING TO DO, and then decide how we can do it and pay for it; instead of arguing the details of how to do it,  and the method of paying for it. Doesn’t “the right thing to do” mean anything to anybody any more? We are looking at this Public and personal health care crisis backwards. It’s time to stop asking people with dementia to be patient with the pace of change in their National organization. It’s just time. Now!