Health Care in America
January 4, 2008
By David A. Goldstein
The solution to our nation’s health care crisis will become apparent only after we accept, as a nation, that our current predicament is dysfunctional and untenable. The impact of our unevenly implemented, inefficient system necessitates that we view health care not as a luxury or a privilege, but as an immutable right. One sixth of our citizens are underinsured or uninsured; the cost of their care is inexcusably high, due in part to delays in service and the use of inappropriate and expensive access points — for example, hospital emergency rooms and urgent care facilities, as opposed to primary care offices.
As we devise an alternative strategy, society and its representatives must embrace the rate of health care inflation, which is contributed to by an aging population and by advances in medical technology that are already in the pipeline. As the percentage of our gross national product consisting of health care costs rises, it will affect society’s ability to purchase durable goods like homes and cars and to pay for other societal obligations such as social security and the military. Society will inevitably adopt formal rationing as a necessity. While rationing has been secretly taking place in many sectors for years and has been discussed and acted upon at the state level in Oregon, it hasn’t yet been the subject of national debate.
The principles underpinning a just distribution of scarce resources, such as health care, are based on the provision of the greatest good to the greatest number. It is crucial that the discussion take place within the public arena and involve the citizenry. It should not be left to politicians behind closed doors. Town hall forum discussions — whether they occur in halls of bricks and mortar or in cyberspace — should lead the deliberations that will be crucial to understanding the public’s values and priorities.
David A. Goldstein is associate professor of Medicine and chief of the Division of General Internal Medicine at the USC Keck School of Medicine. He is also co-director of the Pacific Center for Health Policy and Ethics, which was created in 1991 by the Keck School and the USC Gould School of Law. Goldstein is also vice chair for Clinical Affairs in the Department of Medicine at the Keck School, as well as chief of Internal Medicine at Los Angeles County-USC Medical Center.