Wrong Turn: The Wayward Path of Health Care Reform

The American Medical Association published an opinion editorial with the above title by Jonathon Overlander, PhD, who is an associate professor of social policy at the University of North Carolina, Chapel Hill Medical School. Particularly in view of the recent spotlight on the plight of displaced hurricane Katrina survivors, his comments seem very timely and thought-provoking.

He begins his treatise by stating that "The history of health care reform in the United States has time and again vindicated the pessimists" and notes the failure of some of our most skilled Presidents, including Clinton, Truman, and Nixon to successfully address this issue. His fundamental thesis is that the political system is out of touch with "the worsening realities of the United States health care system", which he believes is characterized by the progressive erosion of private health insurance coverage without a compensatory increase in universal coverage.

Dr. Overlander argues that the short term tax credits for private health insurance, although politically expedient, will have little significant effect on the long term stability of the national health because they will not enable most of the working poor to afford private insurance. The growing trend to decrease the coverage offered to the indigent by Medicaid, combined with the continuing erosion of company-paid benefits, bodes ill for the future of the country.

He cautions that the newly available Health Savings Accounts will actually accelerate the inequities in health care in the U.S. because healthy individuals will flock to such programs to save money, thereby shifting even more of the costs for medical care onto those with chronic illnesses and disabilities. [Such trends do not bode well for the patients we, as prosthetist-orthotists, serve.]

The potential silver lining Dr. Overlander postulates is that, paradoxically, if his thesis is right then America will more quickly be forced to admit that our current health care system is ineffective and this realization will lead to renewed support for more radical solutions. His editorial concludes, however, with this pessimistic paragraph:

"...the United States has shown a prolonged ability to live with a health care system replete with profound inequities and staggering inefficiencies. These compelling realities have never been enough to force decisive political action. There is, as of yet, little to indicate that anything has changed."

The entire editorial is posted online at www.ama.org and is very provocative reading.

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