Healthy, Wealthy, or Wise? Issues in American Health Care Policy

By Charles T. Stewart Jr. | Go to book overview

13
What to Do?
Previous chapters have outlined why radical changes have to be made, and will be made, in the health care system, preferably early and calmly, but more likely late and with much sound and fury and lasting social disruption. In this chapter I discuss what must be done. I do not attempt to propose how it should be done. If war is too important to be left to the generals, health policy is too important to be left to the medical care industry; that is how we got into our present fix. It took decades to arrive here; it cannot be corrected quickly.
What Health System Do We Want?
Reining in health care spending is not an end in itself, only a means toward other ends. So first, what are our goals, what kind of health system do we want? I propose the following goals:
1. 1. Provide universal coverage for health care meeting minimum standards of need and treatment; we are the only advanced nation that does not do this. Curtailment of spending should not be at the expense of this goal.
2. 2. Reduce the share of GNP spent on health care. There is no need to spend twice as large a share of GNP on health care as some advanced countries with universal coverage and better outcomes in terms of infant mortality and life expectancy at every age.
3. 3. Reduce the future increase in share of GNP spent on health care. Some increase is essential to care for an aging population. The effect of technologies yet to be developed cannot be predicted but can be influenced. It is unthinkable that within the lifetime of most of us, we should be devoting one-third of GNP to medical care, which is the implication of current trends. This goal, together with the second goal, seeks to preserve growth opportunities for the economy and maintain and improve people's standards of living.

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Healthy, Wealthy, or Wise? Issues in American Health Care Policy
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Notes viii
  • 1 - Determinants of Health 1
  • Notes 6
  • 2 - Why Are Costs Out of Control? 7
  • Notes 27
  • 3 - Must Living Standards Decline? 28
  • Notes 38
  • 4 - Health Insurance Raises Demand and Supply 40
  • Notes 49
  • 5 - The Excess of Physicians and Services 51
  • Notes 77
  • 6 - The Medicalization of Health 82
  • Notes 97
  • 7 - Mental Illness 99
  • Notes 119
  • 8 - The Excessive Demand for Medical Care 123
  • Notes 136
  • 9 - Research and Technology 138
  • Notes 161
  • 10 - The Physician as Agent 164
  • Notes 179
  • 11 - Prevention: Environmental and Behavioral Modification 181
  • Notes 210
  • 12 - The Demedicalization of Health Care 213
  • Notes 222
  • 13 - What to Do? 223
  • Notes 250
  • Index 253
  • About the Author 263
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