- An acceptable level of overall population health at a reasonable cost requires universal access to health care via single program. This means that residents of all ages are in the same program, without the fragmentation of Medicare/Medicaid, employer insurance, self insurance, and out-of-pocket payment. (I'd leave the VA alone because those patients have unique needs that civilian health care is not set up to handle.)
- Universal access is a prerequisite, not a guarantee
- Improved outcomes and savings require robust federal, state, and community public health policies aimed at containing the dangerously rapid increase in obesity, and the major chronic diseases of asthma, cancer, depression, diabetes, and heart disease. (Obesity is a risk factor in all five)
- Improved outcomes and savings also require a system based on primary care, not specialties. Currently, 30% of U.S. physicians are primary care doctors. The number should be 50%, at least.
- Overtreatment in some areas and undertreatment in others is a problem traceable in part back to the high proportion of specialists
- The state of health information technology is dismal
- As politically significant an accomplishment as it is, the Affordable Care Act mostly buys time and doesn't address the issues of cost or quality. (In fairness, it isn't designed to.)
- Only so much can be accomplished by government at any level. Much reform must come from within the system
- Regarding the economics of American health care, it is supply driven and not demand driven. That is, an area with more heart surgeons with have more heart surgery than an area with fewer, but it is unlikely that overall cardiac health with differ significantly between the two
- My right to access a health care system and the public interest in community health supersedes your right to choose to not access the system
In short, there's much good work to be done...
Yesterday, U.S. District Judge Henry Hudson struck down the portion of the Affordable Health Care that mandates the purchase of health insurance on the grounds that the individual right to not purchase health insurance supersedes anyone else's right to purchase it and the community interest in public health. Ian Millhiser thinks that Hudson's opinion reveals the weakness of the hand being played by the opposition. I think the ruling is not only misguided, it places ideological correctness ahead of addressing what should be considered a threat to our national security. It's simply foolish to be taking an option off the table when it doesn't involve shipping people off to gulags.