Sunday, March 02, 2008

The Spooky Stability of U.S. Health Care

I only read last week a terrific commentary by Lawrence Brown in the New England Journal of Medicine’s January 24, 2008 issue on reform of the U.S. healthcare system and its chances. It’s titled The Amazing Noncollapsing U.S. Health Care System – Is Reform Finally at Hand?, and full text is available free to everyone.

Like Brown, I remember in 1993 when the punditry was pronouncing that health care reform was inevitable (it wasn't). I don’t remember (I was a kid) but have read health care panel discussions on policy from the 60’s amazingly reminiscent of today’s discussions about what an ever-increasing share of the GDP healthcare costs had become and how this was unsustainable. Brown’s article discusses the strong forces that make for stability in our very problematic healthcare system.

DemfromCT at DailyKos noticed the article promptly and commented.

Jeff Goldsmith at the Health Care Blog also comments, but I think takes the discussion in a completely wrong-headed direction by suggesting that this stability is benign. As Brown points out, it is far from that. This stability allows the continuance of the false complacency Americans so frequently have about “everybody getting healthcare” (despite poor kids and adults without asthma medication, cancer patients who can't get treated, lack of dental care and its toll in both physical and mental pain and infection, unavailability of rehab care and needed medical equipment, etc., etc.). It allows the continuance of an expensive idolatry of technology and of rampant, unnecessary, and harmful overtreatment [see Shannon Brownlee's excellent book on the topic of overtreatment]. It allows the continuance of a dangerous and patchy “non-system of care,” as Brown so rightly points out.

But as Brown also points out, the forces making for stability and non-collapse are powerful indeed. If you missed the article too, it’s well worth reading.


Anonymous said...

Great piece. We all have compassion for those who are in pain or need of medical attention. Politicians and the press (60 Minutes March 2 piece on free clinics being offered in rural America) delight in telling us how we have failed as a society for not providing these services at "no" cost to the public at large.

Then we have to deal with reality. We spend more GDP on medical care than any other country in the world. This translate into tremendous profit for a small minority of those involved. Money they are willing to share in order to continue with the system we currently have in place.

My state, while spending little, if any, of the tobacco settlement money on medical care or prevention programs, recently discounted it's settlement money in order to offer property tax assistance to a large segment of the population. This is the very segment that reelects these very same politicians.

We in America believe that with enough money and technology death is an option, and as long as we are spending someone else's money there are no limits. The issue now becomes is everyone entitled to this unlimited source of medical care?

Steve Lucas

Anonymous said...

Hear Hear Steve on your comment - you took the words right out of my mouth.

Anonymous said...

Same debate worldwide, in the UK they're called QALY's, quality adjusted life years. Basically not paying for expensive surgeries if you don't have enough time left to make it practical. The real truth is brutal, but liberating.
Go to:
or buy this guy's book.
What a great expose'!

Anonymous said...

Great post, and there is a health care system, but the least it benefits is the public health and those in need of restoration of thier health that should utilize all resources available to them. Instead, the U.S. Healhcare system is this for profit machine where many more profit from the system than those it is suppose to serve.

Anonymous said...

Interesting information about healthcare in this post, yet ultimately, and in my opinion as a public citizen that is quite aware of the fallacies of the existing healthcare system, what needs to happen is a revolution, which would accelerate all of the efforts implemented by those few to improve this system. More need to become aware and involved in the necessity of ensuring quality public health without corruptive forces.