Curing Health Care Insurance

Jan. 22, 2007 — -- None of us needs to be told. The health care delivery system in America is indefensible.About $2 trillion fuels the system, some 16 percent of our national productivity. If we were all covered, that's more than $6,500 per person.

Despite such a fortune, about 40 percent of us can't afford the care we are told we need, either because we are inadequately insured or out-of-pocket payments would bankrupt us.

Medical bills broke the back of more than 40 percent of us who have declared bankruptcy. Even those who feel adequately insured are bedeviled by difficulties in getting care; those inadequately insured are tormented by them.

Despite outcries, this sorry state continues to deteriorate. Why?

Clearly, the cause is not a lack of money. Every other resource-advantaged country indemnifies its entire population with less than half of what we spend, with better national health statistics to show for it.

The problem must reside in the way the money is spent.

The guiding principle of all health care reform in America is the belief that American medicine is the "best" in the world.

Reform would tackle misdistribution and the inconsistencies in the quality of care. Once these are overcome, all of us will be afforded the "best" to prevent us from getting sick, and the best to heal us when prevention fails.

The savings that would result from a decrease in the national burden of illness would be enough to provide for adequate distribution of care.

It follows that the goal of health care reform is to make certain that American medicine is performed expertly so as to provide optimal quality of care.

Serving this agenda are national committees to establish the criteria for expert care for particular diseases, national committees to collect the data on how particular states, hospitals or practice groups approach these standards, and national committees to see if it matters.

Much of this effort has taken heart disease as the target because of the volume of cases, the costliness of treating these diseases, and the consensus as to the best care. Many a program has been implemented to move practice up to these standards.

Dr. Nortin Hadler is professor of medicine and microbiology/immunology at theUniversity of North Carolina at Chapel Hill, and an attending rheumatologist for University of North Carolina Hospitals.