The health care system has a broad set of functions: supporting chronic disease prevention and management, ensuring people are seen by physicians and receive early diagnosis and treatment for medical problems, providing access to affordable health insurance coverage, and containing costs. The health care system is one of the most regulated industries in the world. Its quality is a matter of concern to many people, as illustrated by high-profile cases in which patients have died after receiving bad care. There are a number of competing theories on how to best improve health care.
One tenet is that competitive markets should improve the quality of care, largely by eliminating so-called “bad” providers and promoting those that perform better. But this premise is valid only to the extent that consumers and other outside evaluators (such as researchers, patient advocates, or even clinicians) can distinquish between good and bad care.
Other people see health care as a public good and argue that the government has a moral obligation to provide everyone with access to it, regardless of their ability to pay. This view is based on the belief that the societal benefits of health care are far greater than the private costs involved. In addition, some health care workers believe that the mystical and spiritual aspects of healing trump mere technical efficiency and cost-effectiveness.
In the United States, there are a variety of ways to provide health care, including private health insurance through employment; single-payer Medicare for seniors and those who are disabled; state-managed Medicaid programs for low-income people; the Affordable Care Act’s marketplace exchanges; and some 28 million people without any type of insurance at all. The government plays a minimal role directly in the financing and supply of health care services, except for the Veterans Health Administration and Indian Health Service hospitals.
Some people who have libertarian sympathies think that government should stay out of the business altogether and allow private citizens to obtain insurance and healthcare as they wish, with the involvement of for-profit and not-for-profit institutions. They worry that the current trends toward integrated finance and delivery of health care and the growth of for-profit companies have negative implications for the quality of health care.
Health care involves a complex mix of scientific, clinical, interpersonal, manual, cognitive, and organizational activities that are difficult to measure objectively. Some important measures are adequacy of care, effectiveness of treatment, and patient satisfaction. Other important factors are safety, accessibility, and cost containment. The United States lags behind many other countries in life expectancy, death rates from preventable or treatable diseases, and access to medical care. People who are uninsured are more likely to forgo care, and those with inadequate coverage are at risk of expensive and disabling complications from chronic diseases such as diabetes and hypertension. Some of the best-performing nations have systems that are a combination of market and command-and-control elements. The United States could learn from these other models. Until it does, the country will be at risk of falling behind its competitors.