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How Can We Reform Health Care?

The United States is the only one of all industrialized nations that does not have some kind of system providing health care to all of its citizens. How can we ignore upwards of 45 million people and growing who do not have access to affordable health care. There are many things on our collective plate that need attention and if ignored will result in grave consequences. We have been discussing this dilemma for many years. Other issues of war and the economy have cast a shadow over the political campaign and now over tackling the challenges ahead. There are few things more fundamental than health, food, shelter and education. We can no longer set aside these issues and ignore their importance or urgency.

Different nations have found a variety of ways to provide universal healthcare to their citizens. Nonetheless they all ended up with similar results. If we are to rebuild America it cannot be done without providing for the health security of our citizens. All health care systems are imperfect but all came from the necessity of circumstances. The health care needs of wartime Great Britain drove them to the obvious and desirable solution of the National Health Service. Although one of the most socialized in the world, health care in United Kingdom has enjoyed a large measure of success and satisfaction over the last 50 years while continuing to thrive. France evolved a similar system starting from a different basic healthcare structure. The end result was access to quality health care of for the entire population in a system which considered by some to be the best in the world. Although the United States may be a leader in medical innovations, we rank 37th in overall services among other countries.

In a recent article in the New Yorker magazine by a practicing physician Dr Atul Gawande, he described the successes of universal health coverage in Massachusetts since its adoption in 2007. The majority of people who had satisfactory coverage in place remain largely unaffected while a sliding scale fee program was established making health care coverage available to all who are uninsured. Choices still have to be made regarding cost containment and most necessary services. However any system has to have oversight and requires difficult decisions be made to continue providing quality and needed services. Overall the Massachusetts plan has been a satisfactory if not entirely perfect success insuring over 97% of its citizens with a very high rate of satisfaction.

We can learn from all of these examples that a change in our health care policy is not only needed but inevitable. History has taught us that issues such as this are path dependent. The most recent Nobel Prize in Economics was given to Paul Krugman for demonstrating how this very phenomenon drives trade patterns and geographic location. It all harkens back to the idea that necessity is the mother of invention. Circumstances and initial steps in our history literally drive the subsequent direction of the outcome. Even if you are ignorant of history you cannot escape its viral influence. The path during this journey has become narrow. We too have reached a point in our history where change must come. The choices are more diminished but are not without merit. They must be bold. But like others before us, we can build on what we have now that works. We can repair what does not work and add choices where there are none. The cost will be an investment that will reap dividends for all of us who share this third rock from the sun.

About Bruce Kaler M.D.

  • bliffle

    OK, Andy: how many?

    Or are you just dragging red herrings across the trail?

  • Brunelleschi

    Dave-

    Apples and Oranges. Rich nation vs poor under decades of embargo.

    Compare Cuba to Jamaica or Honduras, or one of those places ad get back with us.

    At least Cuba has its priorities in the right place, where the US clearly does not.

    America’s mistake, and yours, is the false assumption that the market will magically produce the best health care system.

    Andy-
    Too much money goes in the US simply feeds greed, and leads to a lot of shitty care. “Take a pill and pay your bill” is not a system.

    Look around the world. Open your eyes!

  • http://drdreadful.blogspot.com Dr Dreadful

    Hmm… Jamaican healthcare system.

    Don’t know anything about it, but I do remember a stand-up routine by the black British comic Lenny Henry in which he makes some observations on the laid-backness of all aspects of Jamaican life and contrasts them to the urgency of a typical TV hospital show.

    His depiction of what a Jamaican TV medical drama would be like went something like:

    “[toke] Mmm, we operate in a second… You mus’ not stress because… dese tings take time…”

  • http://www.fontcraft.com/rod/ Dave Nalle

    Compare Cuba to Jamaica or Honduras, or one of those places ad get back with us.

    Honduras, now THERE’s a standard to measure up to. The country which has the highest murder rate in the world, 16 times the rate of violent death of the US and about 30 times the rest of the world, not to mention having no infrastructure and an ongoing near civil war 24/7. A country where any foreigner can expect to get kidnapped and held for ransom within 24 hours of arrival. Woohoo, Cuba has better healthcare than hell on earth. What an accomplishment.

    Dave

  • http://theugliestamerican.blogspot.com Andy Marsh

    So bliffle – legitimate questions are red herrings?

    I still think it’s ironic that this article was written by a doctor…I didn’t notice him mentioning his willingness to take a pay cut to help with the cost of health care coverage?!??!

    But I do understand why he wants it. Everyone knows that the gov’t pays way to much for EVERYTHING it pays for, so, in all honesty, he’s really looking for a pay raise!

  • Brunelleschi

    Dave-

    You don’t even get the irony, do you?

    My point was that Cuba has done a better job than places like that, which pisses you off for some reason.

    Cuba has done a better job under US embargo than Honduras (and the rest) have under the thumb of US control.

    THINK for once.

    Read “Inevitable Revolutions” by LaFeber.

    Educate yourself. You have a LONG way to go.

  • http://theugliestamerican.blogspot.com Andy Marsh

    Honduras is under US control? I had no idea! When did that happen?

  • Clavos

    Don’t believe everything you read, Bru, especially if written by a lefty.

    Have you been to Cuba? I have — numerous times; During the 1990s and early 2000s, I operated (with permits from both governments) B727 charter flights from Miami to various Cuban cities for more than ten years.

    The only good aspect of the Cuban medical system is that they do a very good job training the docs. But once they’re sent out into the field, they have old, antiquated equipment (or none at all), and very few medicines to work with. Most have been reduced to relying on the old “folk medicine” cures, supplemented by whatever they can scrape together. Shortages force rationing.

    The government does operate a handful of well equipped, well stocked top notch hospitals, but these are restricted to top party members and medical tourists (primarily Canadians) who pay in hard currency.

    The effects of the embargo have been greatly exaggerated, especially by apologists for the Castro regime, to excuse the massive failures of Fidel’s revolution. In that sense, the embargo was a very bad strategic move for the US. With no embargo, there would be no excuses for the utter disaster that is the Castro government, and the world would see it for the inept, totalitarian disaster that it is.

    The real problem Cuba faces in terms of the importation of medicines (or food and manufactured goods) is a lack of funding. Ever since the demise of the late, unlamented Soviet Union, Cuba has been plunged into abject poverty in every sector of its economy. Unable, under the Communist economy installed in Cuba by Fidel, to produce exportable goods (or even to feed and provide adequately for their own population), Cuba was totally dependent on the largess of the Soviets, in the form of over $2 billion a year in subsidies, for decades. Since the collapse of the Soviet Union, Hugo Chávez of Venezuela has stepped into the breech, but with only half as much ($1B annually) charity; and even he has pulled back as the price of oil has dropped, leaving him short of cash.

  • Brunelleschi

    Andy-

    Absolutely. Do your research. I have referenced Inevitable Revolutions enough times already. If you want to keep a closed mind, that is your choice.

  • Brunelleschi

    Clavos-

    blah blah blah

    The fact remains that they have their health priorities in order better than the US.

    Shortages are due to politics, we can all agree on that.

  • Clavos

    Bru,

    The fact remains that they have their health priorities in order better than the US.

    blah blah blah

    There’s a wide gulf between setting priorities and achieving them; it’s particularly wide in Cuba.

  • Brunelleschi

    I would not disagree with that!

    Would you chose any other Latin American government, chosen at random, or Cuba?

    The fact remains that Cuba get high praise, and it can’t be attributed to propaganda.

    Cuban drs are held in high regard in most countries, but not here. Wonder why?

  • Brunelleschi

    I just listened to a lecture about Jeremy Bentham and John Stuart Mill and thought about this thread.

    Bentham was the guy we get “greatest good for the greatest number of people” (utilitarianism) from.

    What would Bentham or Mill think about this one?

    :)

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Here you go, Brune. Waiting for a philosopher to assess our present conditions and come up with a remedy.

  • Brunelleschi

    Not exactly.
    Philosophers are very useful in helping us think outside of the box.
    They don’t make roadmaps to the answer, they just give directions.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    I don’t disagree and you know I wasn’t being facetious. It’s just that there’s so of the ideological going back and forth, it’s extremely difficult for a person to stay aloof and start thinking clearly. The major exponents of the Left, like Zinn or Chomsky, are not doing their job. They’re as much into the fray as anyone else, even more so. It’s not from them that we can expect clear-headed solutions.

  • Brunelleschi

    Agree. Zinn and Chomsky are important critics, but so are we, right?

    :)

  • Cindy D

    LOL Zinn and Chomsky are not doing their job.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    I think you’re right, Brune. This whole issue has got to be re-conceptualized in terms of new ideas, not just facts. Interesting you thought of Bentham and Mill, the chief antagonists of their time. You might have something there by way of a general argument. Later.