Compared to other western nations, the U.S. is assigned low grades based on the amount of money spent on health care and the results that are achieved. A typical analysis shows that lacking a public commitment to universal health care, this nation instead is a product of bio-scientific free enterprise – technologically sophisticated, extremely expensive, but inaccessible to the poor. A contrasting account can be found in a paper in the University of Texas Public Law & Legal Theory, Research Paper Series (#581), which will be a chapter in a book scheduled for publication in 2019. Its author, William Sage, indicates that beginning over 20 years ago, the poor performance of the American health care system has been slowly revealed. For nearly as long, steps that might improve that performance have been identified, but little has changed. The answer to why there has been a lack of significant progress lies in large part to an accumulation of laws, regulations, self-regulatory practices, and financial subsidies which locks U.S. health care into inefficient, unfair patterns and practices. While most of these provisions were well-intentioned when developed, this “deep legal architecture” now serves mainly to prevent meaningful competition in medical markets and to distort or limit collective investment in the nation’s health.
Noting that the United States wastes a vast amount of money each year on ineffective, overpriced, poorly delivered, and inaccessible medical care, the author offers three lessons that seem most important to summarize. First, the various ideological “brands” associated with national health reform must realign themselves to the task of facilitating decentralized, incremental improvement rather than asserting a national political consensus on setting limits. Second, in addition to continuing routine enforcement of the antitrust laws, the U.S. Department of Justice and the Federal Trade Commission should pursue longer-term strategies intended to reverse the distortions currently burdening competition. Third, America’s spendthrift health care system is particularly problematic because it leads the political process to medicalize problems such as poverty, lack of education, and substandard housing while over-investing in medical care and under-investing in non-medical social services that would be less costly, more effective, and more accessible to disadvantaged segments of the population.
More Articles from TRENDS September 2018
FULFILLING A QUEST FOR PATIENT-CENTERED CARE
Patient-centered care is an important aspect of service delivery, but more efforts are needed to achieve its full potential. Read More
PRESIDENT’S CORNER—ASAHP MEMBER FOCUS
Charles Gulas, Dean of the Walker College of Health Professions at Maryville University of Saint Louis, is featured in this issue of TRENDS. Read More
FISCAL YEAR 2019 FUNDING PICTURE BRIGHTENS
For the first time in 15 years, Congress manages to complete a funding package for health and education prior to the start of the next fiscal year on October 1. Read More
HEALTH REFORM DEVELOPMENTS
Some states seek workforce requirements for certain Medicaid recipients, a challenge is mounted to stop an expansion of short-term health insurance plans, and savings are produced by accountable care organizations. Read More
DEVELOPMENTS IN HIGHER EDUCATION
Opponents respond to a Trump Administration proposal to rescind gainful employment regulations, representatives of various interest groups testify at a U.S. Department of Education hearing on accreditation, and Congress increases appropriations for education programs. Read More
QUICK STAT (SHORT, TIMELY, AND TOPICAL)
Prevalence Of Chronic Pain And High-Impact Chronic Pain Among Adults—United States
Daily Use Of Marijuana Among Non-College Young Adults
Micromotor Pills As A Dynamic Oral Delivery Platform
Using Biomimicry To Develop Solutions For Human Health Problems Read More
AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY
Creating A Policy Environment To Address Social Determinants Of Health
Population Health: Translation Of Research To Policy
Achieving Rural Health Equity And Well-Being: Proceedings Of A Workshop Read More