This is the fourth and last installment of the mini-series, "Why We Need Fundamental Health Care Reform." This posting focusing on the question of the quality of care in the current health care system in the U.S.
- Lack of health insurance contributes to lacking basic access to care—more than 22,000 working-age Americans die annually because of lack of insurance. The brutality of our health care "system" is almost beyond comprehension in every European nation, and dozens of others around the world because in other countries health care really is organized as a system, is considered a right of citizenship, and is not denied to low-income citizens.
- Those who lack adequate health insurance coverage often use inefficient points of care, such as emergency rooms, that drive costs up for everyone and increase ER waits—even for the insured. More importantly, however, is that being forced to use emergency rooms inappropriately due to lack of funds or insurance means there is no continuity of care as would be provided in a "medical home," for example by a family physician who is used by the entire family year after year.
- Our fragmented health insurance system subverts quality assurance and often discourages innovative, even adequate disease prevention and/or management.
- While spending vastly more per person, the U.S. is nineteenth among nineteen rich nations in the avoidance of preventable deaths before age 75. Profits are extraordinarily high in the American health care industry, but that does not necessarily equate with a system that delivers good health care.
- Doctors, nurses, and other providers are shunning primary care, resulting in critical shortages in this segment of health care. We know that, dollar for dollar, primary care--think "family practice"--is far more effective on its impact on the health of the community and the people as a whole than is costly high-tech medicine. We also know that it is far less profitable, and left on its own, medicine will follow the money.
- Large disparities in care hurt minorities, women, and rural populations. Low-income populations and rural populations are generally not profitable populations, so health care providers generally do not go out of their way to provide health care to them. This is how the medical marketplace works. This is also a major contributor to disparities in access to, and quality of, health care for tens of millions of Americans.