NY Times: America can afford a world-class health system. Why don’t we have one?

Yesterday’s NY Times had a terrific review section of the paper with the theme of “The America We Need.”  The section highlighted the interaction between the coronavirus and inequality, unemployment, collective action, and emerging threats (eg. climate change).

The article with the most relevance for medicine was titled: America can afford a world-class health system. Why don’t we have one?

Here’s an excerpt:

The notion of price control is anathema to health care companies. It threatens their basic business model, in which the government grants them approvals and patents, pays whatever they ask, and works hand in hand with them as they deliver the worst health outcomes at the highest costs in the rich world.

The American health care industry is not good at promoting health, but it excels at taking money from all of us for its benefit. It is an engine of inequality…

America is a rich country that can afford a world-class health care system. We should be spending a lot of money on care and on new drugs. But we need to spend to save lives and reduce sickness, not on expensive, income-generating procedures that do little to improve health. Or worst of all, on enriching pharma companies that feed the opioid epidemic.

The first step to reform is to change the way we think…It would be more accurate to think of employer-provided health insurance as a tax….

Employer-based health  insurance is a wrecking ball, destroying the labor market for less-educated workers and contributing to the rise in “deaths of despair.”…

To meet those rising costs, states have cut their financing for roads, bridges and state universities. Without those crucial investments, the path to success for many Americans is cut off. We face a looming trillion-dollar federal deficit caused almost entirely by the rising costs of Medicaid and Medicare, even without the recent coronavirus relief bill…

Americans have too few doctors, too few beds and too few ventilators — but lots of income for providers. While millions suffer, our health care system has turned into an inequality machine, taking from the poor and working class to generate wealth for the already wealthy…

The health care industry has armored itself, employing five lobbyists for each elected member of Congress. But public anger has been building — over drug prices, co-payments, surprise medical bills — and now, over the fragility of our health care system, which has been laid bare by the pandemic…

Employer-based health care is a particular nightmare in this pandemic. In recent weeks, millions have lost their paychecks and their insurance, and will have to face the virus without either.

We are believers in free-market capitalism, but health care is not something it can deliver in a socially tolerable way.

My take: Many health care workers and hospital employees are showing incredible courage and compassion in this pandemic.  This article reminds us of all the work needed to improve our health care system.

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