The American Healthcare "System" in 2005 -- Part 1: Context

Editor's Note:
American Health System Reform has returned to the front burner for 2007-2008. MedGenMed ran a sequence of Webcast Video Editorials in 2005 that tried to tell the whole story -- past, present, and proposed future -- in 7 easy lessons. It was well received then with high readership but the politics was cold. The situation in American healthcare has not changed fundamentally since 2005, except that conditions have worsened and a new presidential campaign is upon us. Ergo, the politics of health "system" problems is now hot. So, we are republishing all 7, in order, on sequential Thursdays. Read, enjoy, or get angry, but let us know what you think. Send us your reactions, proposals, serious health policy articles, letters, brickbats, essays, whatever. Help us boil the pot to inform the profession and the populace.

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The US healthcare "system," and reform thereof, almost defies characterization, except perhaps as an elusive moving target. It is immensely complicated, almost inexplicable, costly beyond belief, seriously discriminatory, and often unsafe. It is responsive, if at all, to multiple regionally and demographically varied forces. These include patients (also known as consumers), providers (a term generally loathed by physicians), purchasers (of health insurance), payers (for healthcare products and services), and the various controllers of these players, such as the federal and state governments, professional associations, industry, and academia -- especially the education and research enterprises. Myriad groups function as connectors at interfaces, such as communications and computer companies, and as scavengers at the fringes, such as liability attorneys.[1] One overriding element is crystal-clear. The money expended from all sources in American healthcare is extraordinarily large, some $1.7 trillion in 2004, one seventh of the total US economy, and larger than the total economies of most countries of the world. This cost is in excess of that of any other country, when measured in total, as a percentage of the gross domestic product (GDP), per capita, or by outcomes. Worse yet, even though awash in money spent, over 45,000,000 Americans are without health insurance. That's my opinion. I'm Dr. George Lundberg, Editor of MedGenMed (to be continued).

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