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Healthcare Reform, Medicine, Public Health

Is the US Healthcare System “health care” or a “system”?

To use the word “system” to describe healthcare in the United States is to imply intentionality, coordination, and comprehensiveness, none of which can be appropriately applied here.

The US “system” of Personal Sick Care Services is constituted by the world’s most expensive diagnostics and procedures delivered through a fragmented assortment of socialized federal care centers for military veterans, public and private hospitals, community clinics, public health departments, and private providers paid for by federal outlays, federal and state programs (such as Medicare and Medicaid), socialized insurance programs for elected officials and federal employees, employer-sponsored private insurance programs, and out-of-pocket costs.

Despite the enormity of healthcare spending (approximately $2.9 trillion in 2014), and the not-infrequent bankruptcy of individuals and families that can result from the unparalleled cost of US healthcare services, both quality and access are shockingly low. A large fraction of people in the US lack health insurance coverage (currently ~11.4%, down from ~18% in 2013), and an even larger fraction lack practical access to primary and specialty care (37% in 2013 due to cost-related barriers alone, according to a Commonwealth Fund study). In addition, health outcomes among those accessing the world’s most expensive care are, in several important categories, well below OECD averages.

Healthcare in the US might truly become “health care” if 1) a great deal of the political, intellectual and technological attention currently focused on sick care were reallocated to addressing the social determinants of health and primary prevention; 2) a single-payer, universal coverage system were implemented to maximize access and reduce healthcare expenditures to sustainable levels, and 3) fee-for-service models were abolished and drug prices were severely restricted to fundamentally reorganize the economic incentives and financial influence on policy of the medico-pharma industrial complex towards sustaining health and preventing disease for the entire society rather than only managing the diseases of those best able to pay.

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