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John E. McDonough, Brian Rosman, Fawn Phelps, and Melissa Shannon The Third Wave Of Massachusetts Health Care Access Reform Health Affairs, November/December 2006; 25(6): w420-w431. [Abstract] [Full Text] [PDF] [Table of Contents] [Reprints & Permissions]

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Looking For Reform In All The Wrong Places: Massachusetts, Money, And Health Care

Rick J. Carlson, JD   ( 27 September 2006 )

Looking For Reform In All The Wrong Places: Massachusetts, Money, And Health Care 27 September 2006
Rick J. Carlson, JD, Clinical Professor, Policy Programs, Department of Health Services University of Washington Send comment to journal: Re: Looking For Reform In All The Wrong Places: Massachusetts, Money, And Health Care rickjcarl{at}aol.com Rick J. Carlson, JD	U.S. health care policy is always about the business of health care -- paying for it and delivering it. This is a fatal flaw: it is medicine that should be the focus of reform, and only derivatively the system that delivers it. Over the last ten years we have poured $15 trillion into health care. Yet we are less healthy now than in 1995? And what about the next ten years? Why would we expect better results after another $ 20-30 trillion for more of the same thing? We can’t answer these questions because we don’t ask them. The Massachusetts model, which only addresses the ways money is raised and used, might be sound business policy, but it is profoundly dishonest health care policy. Our health care system is the most spectacular business success -- ever. Through privatization, public policies have consistently enabled its growth. Our government is just a “dumb” terminal to process payments. We have failed to invest in information technology and failed to fund studies measuring value for money. Most deplorably, we have failed to define value collectively and to insist on getting it. In our failure to ask what public values our system should advance to balance private interests, we default to mass and sustainable markets of maintenance medicine for the chronically ill. The rising tides of obesity and diabetes are evidence enough. Our venerable medicine has simply become the product our system can sell at a sustainable profit. This kind of medicine causes disease by failing to prevent it. The U.S Treasury buys $1.2 trillion of health care a year -- using our money. It should buy for all of us, not just those lucky enough to get the right disease.