Why Health Policy Needs a Safe Harbor for Continuity
To the Members of Congress,
I am writing in response to recent reporting on President Donald Trump’s new health care proposal, including coverage by the Associated Press that outlines its goals, tradeoffs, and likely points of contention.
I am not writing as a partisan.
I am writing as a physician–scientist who has spent decades inside clinical care, biomedical research, and public health systems—and as someone who has lived with the consequences of how those systems are designed.
When Health Care Systems Fracture, People Fall Through
Over time, one lesson has repeated itself with painful consistency:
When health care systems are fractured, people fall through the cracks.
Fracture is not an abstraction. It is operational and human:
- Repeated handoffs with no continuity of responsibility
- Funding cycles that end before biological processes do
- Policies optimized for short-term metrics while human lives unfold across decades
In fractured systems, continuity becomes an exception—something clinicians try to patch together despite the design, not because of it.
What Fractal Design Makes Possible
A fractal health care system is fundamentally different.
In a fractal design, the same organizing principles hold at every scale:
- the individual clinical encounter
- the care team
- the institution
- the agency
- the national policy framework
When values align across these levels, continuity is no longer a special project. It becomes a design feature.
Fractal systems are:
- More humane, because responsibility does not disappear at boundaries
- More resilient, because continuity is preserved through transitions
- More trustworthy, because patients can rely on the system over time
A Safe Harbor for Continuity
This is my appeal to Capitol Hill:
Whatever policy path you choose, govern for fractal coherence.
That means:
- Protecting continuity across life stages, not just enrollment periods
- Aligning incentives so what works for a clinician in the room also works for the institution and the nation
- Creating a safe harbor for care that must persist through uncertainty, political change, and biological time
Health care does not fail because clinicians lack commitment.
It fails when systems are not designed to carry people through complexity.
With respect,
Lawrence M. Nelson, MD, MBA
Women’s Health Surgeon, Physician, Scientist
Former Principal Investigator, NIH Intramural Research Program
CAPT, United States Public Health Service (Retired)
Read the full AP story:
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