The Spooky Stability of U.S. Health Care

I only read last week a terrific commentary by Lawrence Brown in the New England Journal of Medicine’s January 24, 2008 issue on reform of the U.S. healthcare system and its chances. It’s titled The Amazing Noncollapsing U.S. Health Care System – Is Reform Finally at Hand?, and full text is available free to everyone.

Like Brown, I remember in 1993 when the punditry was pronouncing that health care reform was inevitable (it wasn't). I don’t remember (I was a kid) but have read health care panel discussions on policy from the 60’s amazingly reminiscent of today’s discussions about what an ever-increasing share of the GDP healthcare costs had become and how this was unsustainable. Brown’s article discusses the strong forces that make for stability in our very problematic healthcare system.

DemfromCT at DailyKos noticed the article promptly and commented.

Jeff Goldsmith at the Health Care Blog also comments, but I think takes the discussion in a completely wrong-headed direction by suggesting that this stability is benign. As Brown points out, it is far from that. This stability allows the continuance of the false complacency Americans so frequently have about “everybody getting healthcare” (despite poor kids and adults without asthma medication, cancer patients who can't get treated, lack of dental care and its toll in both physical and mental pain and infection, unavailability of rehab care and needed medical equipment, etc., etc.). It allows the continuance of an expensive idolatry of technology and of rampant, unnecessary, and harmful overtreatment [see Shannon Brownlee's excellent book on the topic of overtreatment]. It allows the continuance of a dangerous and patchy “non-system of care,” as Brown so rightly points out.

But as Brown also points out, the forces making for stability and non-collapse are powerful indeed. If you missed the article too, it’s well worth reading.