Why We Need Health Reform
This is a guest post by Dr. Joshua Freeman, a family physician, educator and author of the blog, Medicine and Social Justice. This quote serves as an introduction to his blog: “The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough to those who have too little.” — Franklin D. Roosevelt
Why We Need Health Reform
by Joshua Freeman, MD
As we wait to see if the President’s health reform bill passes, it is a good time to review the actual core reasons why we need health reform. I believe that this will help ground us, and allow us to evaluate both whatever finally passes, and help us ignore the political posturing and maneuvering that distract us from them.
- Access to health care. Remember 45 million uninsured people? Remember at least 75 million uninsured and underinsured? Remember the rising rates, co-pays and deductibles, and decreases in coverage that limit access even for those with insurance? This is absolutely key, and it is absolutely amazing that is all but disappeared from the discussion. In addition we have the current dearth of primary care, demonstrated in Massachusetts but apparent everywhere, with dread for the future because of the lack of interest in these fields by current students.
- Cost containment. As the cost of health care approaches 20% of GDP, this becomes a more and more serious problem. What are the causes? Inefficiency and redundancy? Insurance company greed? Physician and hospital greed? Infatuation with technology? Malpractice? How can they be addressed at the same time as ensuring #1, access to health care for everyone. And leaving some money over for other programs that address goal #3:
- Health. Ultimately, the goal is to improve our health, not our health care except to the extent that it is a tool for doing so. But much else affects health – genetics (about which we can do little), health behaviors and poverty and environment (about which we, as individuals and a society, could do much but about which we in fact, as individuals and a society, do little).
We need to look at the whole, not bits and pieces. In my opinion, a single-payer system, while not a panacea, is the right place to start. It will cover everyone and save lots of money from the start. It provides a mechanism for controlling costs in the future, for encouraging a more appropriate health workforce and programs beneficial to health rather than to profit. Whether you agree with this solution or not, it is by the degree to which they address the core issues above that any reform should be judged.