All rhetoric, No substance.
The remaining candidates have it all wrong. The Republican candidate make no pretense of caring for the uninsured and has no idea that the health care system is imploding. The Democratic contenders, while aware there are problems seem to think all they have to do is provide insurance coverage! The Massachussetts program is in deep financial trouble. The California program died in committee. The New Jersey plan is unlikely to go anywhere as it only focuses on insurance, mainly for children. Until the plans stop looking at hospital costs and freedom of choice for anything one wants, and focuses on a primary care home for everyone, and sets limits to interventions there will be nothing except sets of new unfulfilled promises. It is time we learn from every other nation in the world that access to health services has to start in the primary care arena, with a single practice responsible for comprehensive care, acting as a gate keeper. Further. such care has to place an emphasis on preventing disease, not just intervening after symptoms occur. There is no way any system can pay for everything. There must be be evidence that interventions work, particularly in the realm of all the "me-too" prescriptions, many of which are overpriced and undereffective. Prescription advertising has to stop.. Any program that ensures population wide access must include a system that precludes some interventions as too expensive and inneffective. This is even more important with all the new research in genetics that will translate into useful inteventions within the next decade, and the associated population boom..
Comments
Underlying all healthcare issues is cost. In that respect, what is happening in healthcare is reflective of what is happening globally in all developed countries since the industrial revolution and especially post WWII, i.e. the increasing consumption of limited resources leading to an increased standard of living supported by technological development. As they say in Sociology 101, populations do not voluntarily lower their standard of living but unfortunately often erase debt and garner further resources through war. Lowering the standard of living and redistribution of resources is tantamount to no longer expecting zero risk in healthcare, i.e. the comment about data based decision making when utilizing expensive technologies. Controlling costs also means "fiddling" with a gorilla size healthcare economy that potentially would result in loss of corporate income and jobs. Of course we all expect the market share war to bust at somepoint anyway, it is just who is to be the one responsible and whether we take our hits now or later in a more severe crisis environment. Many feel the only way to control cost is a single purchaser, i.e. government. This of course assumes a government that would not react preferentially to lobbying efforts. So where does that leave us? Cautiously optimistic at best that a major system change will lower costs and that a population not yet experienced in a pandemic with ineffective and/or limited resources will accept the change.
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