One of the more frustrating things about political discussions is the focus on minutia and news cycles over context and perspective. So indulge a brief trip in the Wayback Machine. Ten years ago this month, the Institute of Medicine, one of the National Academies, released a groundbreaking report on quality in the U.S. health care system called Crossing the Quality Chasm. This came on the heels of another huge IOM report, To Err is Human, which was a pretty sobering look at patient safety in our system. The overall point of Crossing the Quality Chasm was that we can do a great deal better, but our system needs to evolve--that is, we need to try new approaches. Or, from one of the quality experts and clinicians involved in the work, a better summation of the Institute of Medicine's point: That quote comes from an old paper I stumbled over recently, a "user's manual" to understanding that "Quality Chasm" report. But more interesting is the outline in that paper of the vision of a new, improved, smarter health care system. These are the pillars such a system would be based on: It's been a decade but the efforts to build an intelligent, coordinated, and evidence-based system that revolves around the needs and input of the patient still have a ways to go. But it's a lovely dream.