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 incentives for hospitals and doctors do not align with patient interests. unsatisfactory, 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 is the leading cause of bankruptcy.”
“(The American Medical Association) rejects the view that the status quo is acceptable or that it is too politically difficult to achieve the changes needed. Dr. Atul Gawande writes: Genius. No. We need diligence. We need moral clarity. We need ingenuity. Physicians) has demonstrated a desire 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 February of that year, where I ignited a passion for reform, but the keynote speaker said, “Health care coverage for everyone.” was only heard declared politically unfeasible.
The speaker was Pole Starr, professor of sociology and public relations at Princeton University and winner of the 1984 Pulitzer Prize for non-fiction. I was crushed.
If the time was right, it was 2020.
pandemic
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 health care reformers, the gradual and growing changes that began with the Affordable Care Act (also known as “Obamacare”) or “Medicare for All” addressed a dysfunctional health care system. There is disagreement as to whether it is the best way to do 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 called our profit-driven system a “tapeworm” that undermined 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 ways in which care is delivered. Administrative bloat and waste, yes, it is hard to believe.There is no denying that in our current system too few resources are used to address the social determinants of disease.Quality of life and averages The actual improvement in life expectancy is .
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 who cannot afford medical insurance are provided with it by law, but people can purchase private health care. Insurance if they want.
First, we have to face the fact that our current health care system is too expensive, unfair, and does not provide the health 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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