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Health Care PolicyPreventive MedicinePrimary Care

The Health Care Reform Conundrum – 1

By September 5, 2009No Comments

The best of American medical care is awesome. We can now cure people of diseases that weren’t even well understood a few years ago. We can effectively mitigate a large portion of serious chronic diseases that used to substantially shorten many people’s productive lives. The biomedical and information technology explosion of the past 20 and more years is paying immense dividends.

Yet our system fails badly by many standards. It costs too much. Not everyone really has access to the full range of modern medical services. And our achieved quality of care is uneven. By comparison to many industrialized nations, the health care outcomes for our society as a whole are measurably poorer.


Over thirty years ago, I spent two years working with the federal government  in the Public Health Service at an agency whose mission was to evaluate the reasons that the cost of medical care was too high, the access to care too imperfect, and the quality too spotty.

Access, cost and quality. The same mantras from the 1970’s are still on the front page of the remaining newspapers and in public discussion on a daily basis as the Congress and the Obama administration attempt to reform “health care” in some fashion.

Health Care Is Much More Than Health Insurance

Our health care system is immensely complex. It is the single largest component of our economy, but the parts are really heterogeneous. Congress has stumbled and is bogged done simply trying to clean up health insurance, which is important but still just one small part of the whole. Portions of the public go ballistic over tiny issues usually based upon profound misunderstandings. “Keep the Government out of my Medicare” is a frequently reported rallying cry. But if we can’t get substantive public discussion going, discussion that leads to understanding and communal problem-solving, then I expect we will be no more successful this go-round than we were with the Hillary health plan fiasco in 1994, which I remember too painfully.

My Views

I believe that no person or organization can claim truly comprehensive knowledge of the health care system sufficient for everyone else to just follow their lead. We have doctors of all stripes around the country, the big and little pharma industry, the hospitals in big cities and the rural areas, the poor and underserved, the academics who attempt to compare measures of care around the country and between countries, the public health establishment, the advocates for the unserved minorities, and the insurance companies, who are interposed between the providers and you, the individual patient who is immensely concerned that you and your family get the best health care possible, but who may have little familiarity or understanding as to why health care is so complex and why it is such a costly mess.

Future Posts on Health Care

To help your understanding of our health care conundrum, I will begin to write a series of short discussions on important but manageable pieces of the health care system, to try to succinctly explain their complexity and what works and what is off the mark and why, and what types of realistic changes would improve the situation.

The reality of each piece of the system, whether large or small, is almost always more complex than most people realize. My challenge will be to present each issue clearly and succinctly so you have a useful analysis to ponder and to help you participate in our public discussion. I hope many of you will add comments, whether supportive or amplifying or contradictory.  Thoughts on exact topics to present are also welcome, since the agenda is enormous and a compelling specific organizing principle is difficult to discern.

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