COMMENTARY

The American Healthcare "System" in 2005 -- Part 5: 2 Good Options for Fixing Our Broken System

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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In Part 1 of this series, we painted a broad-brush picture of our broken healthcare system.[1] In Part 2, we argued that no one is in charge and that anarchy and chaos exist side by side.[2] Next, we extolled the virtues of consumer-driven healthcare, but lamented that such could only fix some problems.[3] Later, we praised the goals of the advocates of a "single-payer" system while chiding them for their fatal rhetorical flaw.[4] Here we describe 2 acceptable alternatives, while holding our preferred reforms for next time.

The 4 greatest achievements of the American 20th century were: emerging from the Great Depression, winning the Second World War, enacting Social Security, and enacting Medicare. By far, the simplest way to fix our broken system would be to roll out "Medicare for All." Government is very good at collecting and dispensing money. Medicare is private medicine with efficient government funding. Medicare's greatest critics come from within medicine, but by the most important objective measures -- access, cost, quality, outcomes, and patient satisfaction -- Medicare comes out on top and would do very well if applied to all Americans, after a few touch-ups of its rough edges. Managed care, anathema to many, when well run and not-for-profit, can be very good indeed. I would be quite comfortable with a universal equivalent of "Kaiser Permanente America," perhaps organized regionally for efficiencies of scale.[5] Again, in the key elements -- access, quality, cost, outcomes, and patient satisfaction -- such a system would excel.

Alas, I do not believe that the ideological bent, intellectual grasp, and power equation of our current dominant political groups would be able even to openly consider these 2 alternatives, much to the potential loss of our citizenry.

That's my opinion. I'm Dr. George Lundberg, Editor of MedGenMed .


Readers are encouraged to respond to the author at glundberg@medscape.net or to Paul Blumenthal, MD, Deputy Editor of MedGenMed, for the editor's eyes only or for possible publication via email: pblumen@stanford.edu

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