It’s long overdue to reform the U.S. healthcare system [column] | | Local Voices

When I retired in January 2020 after a 40-year surgical career, the American College of Physicians published a journal supplement.

These quotes made their point very clearly and urgently.

— “The U.S. healthcare system is seriously ill and has many symptoms. It is too expensive, many people do not have affordable insurance, and hospital and doctor incentives are not aligned with patient interests. Not, primary care and public health are underestimated, spent in management at the expense of patient care, and vulnerable individuals face difficult barriers to care. It’s the leading cause of bankruptcy.”

“(The American Medical Association) rejects the view that the status quo is too politically difficult to achieve acceptable or needed change. It takes diligence, it takes moral clarity, it takes ingenuity, and most of all, it takes a willingness to try.By articulating a new vision of healthcare, the American College of Physicians , demonstrates our willingness to make America’s health care system better for all, and we encourage others to join us.”

Preparations for the 2020 election were just beginning, and Senator Bernie Sanders was making waves with the drumming of “health care for all.” I attended the Leonard Davis Institute for Health Economics Conference at the University of Pennsylvania in his February of that year, and ignited a passion for reform, but the keynote speaker was “covering health insurance for all”. was only heard declared politically unfeasible.

That speaker was Paul Starr, professor of sociology and public affairs at Princeton University, who won the Pulitzer Prize for nonfiction in 1984. His masterpiece is “The Social Transformation of American Medicine: The Rise of the Sovereign Profession and the Formation of a Vast Industry”. I was crushed.

If the time was right, it was 2020.


At the same time, a new coronavirus was beginning to emerge that seemed certain to change everything. But is it?

It’s been two and a half years since a pandemic that killed more than a million Americans and exposed the shortcomings of America’s healthcare “system.” These shortcomings are more serious than the reformers who promoted “medical insurance for all” explain.

In June, the peer-reviewed journal of the National Academy of Sciences found that the single-payer universal health care system “saved 212,000 lives in 2020 alone,” and that more than 338,000 lives have been saved from the pandemic so far. Elapsed.

The study also found that “$105.6 billion in medical costs associated with hospitalizations due to COVID-19 could have been avoided by a single-payer universal health care system over the course of the pandemic.”

The lives lost due to medical expenditures and inadequate health insurance underscore the need for reform.

Allison Galvani, director of the Center for Infectious Disease Modeling and Analysis at the Yale School of Public Health and lead author of the study, said: “Americans are losing lives and money needlessly.”

useless and unfair system

Among reformers, the gradual and growing change that began with the Affordable Care Act (also known as “Obamacare”) or “Medicare for All” has led to a dysfunctional healthcare system. There is disagreement as to whether it is the best way to deal with it.

Margot Sanger-Katz’s analogy in a September 2019 New York Times column was the perfect way to illustrate this choice. Our healthcare system is an old house. Is it a fixer upper or does it have to be dismantled and rebuilt?

Yes, dismantling and rebuilding this huge element of our economy will be resisted by the owners of the goose that lays the golden eggs… the beast. Business mogul Warren Buffett famously described our profit-driven system as a “tapeworm” that undermines the competitiveness and efficiency of the economy and the health of all Americans.

Our system is wasteful and unfair. It seems that priorities are forgotten and profit is seen as more important than patient care. The irony of demanding government-run health care in the face of our government’s long history of inefficient bureaucracy is not lost on me, but the current administration of the way care is delivered. The bloat and waste of is, yes, hard to believe. There is no denying that in our current system, too few resources are used to address the social determinants of disease.

But it’s also important to recognize that countries with single-payer health systems are dealing with rising costs and the dreaded R-word: rations. Along with medical finance reform, Must Change the way medicine is done.

Both patients and providers must change our culture. We are addicted to high-tech disease interventions. We need to emphasize low-tech primary care, prevention, education and individual responsibility, and make serious efforts to change the social determinants of disease such as poverty and racism.

We must be willing to consider options other than Medicare for All. For example, in the American version of the German system, health insurance is compulsory and people can purchase private health care, although health insurance is provided by law to those who cannot afford it. Insurance if they want.

First, we have to face the fact that our current healthcare delivery system is too costly, unfair, and does not provide the care we all need and deserve. we can do better. As American surgeon Atul Gawande put it, this requires “moral clarity,” “ingenuity,” and “willingness to try.”

Dr. Edward T. Chory is a former Lancaster General Surgeon.

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