How Can We Reform Health Care?

The United States is the only one of all industrialized nations that does not have some kind of system providing health care to all of its citizens. How can we ignore upwards of 45 million people and growing that do not have access to affordable health care? There are many things on our collective plate that need attention and if ignored will result in grave consequences. We have been discussing this dilemma for many years. Other issues of war and the economy have cast a shadow over the political campaign and now tackling the challenges ahead. There are few things more fundamental than health, food, shelter and education. We can no longer set aside these issues denying their importance or urgency.Each country that has accessible health care for its citizens has followed a different path driven by similar but different circumstances. Nonetheless they all came to the same conclusion. If we are to rebuild America it cannot be done without the security and stamina of our very selves. All health care systems are imperfect but all were driven by necessity of circumstances. The health care needs of wartime Great Britain drove them to the obvious and desirable solution of the National Health Service. Although one of the most socialized in the world, health care in United Kingdom has enjoyed a large measure of success and satisfaction over the last 50 years while continuing to thrive. France evolved a health care solution over the same period of time adding to what was already working in gradual steps. The net result is accessibility to quality health care of its population considered by some to be highest ranked in the world. Although the United States may be a leader in medical innovations, we rank 37th in overall services among other countries.In a recent article in the New Yorker magazine by a practicing physician Dr Atul Gawande, he described the successes of universal health coverage in Massachusetts since its adoption in 2007. The majority of people who had satisfactory coverage in place remain directly unaffected while a sliding scale fee program was established making health care coverage available to all who are uninsured. Choices still have to be made regarding cost containment and most necessary services. However any system has to have oversight and requires difficult decisions be made to continue providing quality and needed services. Overall the Massachusetts plan has been a satisfactory and an imperfect success insuring over 97% of its citizens with a very high rate of satisfaction.We can learn from all of these examples that a change in our health care policy is not only needed but inevitable. History has taught us that issues such as this are path dependent. The most recent Nobel Prize in Economics was given to Paul Krugman for demonstrating how this very phenomenon drives trade patterns and geographic location. It all harkens back to necessity is the mother of invention. Circumstances and initial steps in our history literally drive the subsequent direction of the outcome. Even if you are ignorant of history you cannot escape its viral influence. The path during this journey has become narrow. We too have reached a point in our history where change must come. The choices are more diminished but are not without merit. They must be bold. But like others before us, we can build on what we have now that works. We can repair what does not work and add choices where there are none. The cost will be an investment that will reap dividends for all of us who share this third rock from the sun.

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