USA, Health Care for All?
Determinants of Health and Their Contribution to Premature Death.
The ideas on health care reform that are being taken seriously in state capitals and in the 2008 presidential campaign are variations on this theme. No plausible presidential candidate is urging a European-style program of generous public insurance for all. Like the Massachusetts plan, the proposals from John Edwards and Senator Barack Obama (D-IL) patch together existing public programs, employment-based coverage, insurance market reforms, and new public subsidies. Their proposals have the potential to achieve near-universal coverage and to improve the quality of care. Senator Hillary Clinton (D-NY) is expected to offer a similar package.
These ideas will disappoint proponents of more sweeping reform aimed at achieving uniformly generous coverage for all. link link
But this strategy responds to the anxieties of working Americans, who accept that they must, in the main, depend on themselves. It supplies a safety net when self-reliance falters because of large economic and social forces. And it shields the poor from the degrading, life-endangering consequences of going without basic care because they cannot pay for it. It calls on all of us, though, to take greater personal responsibility for our health, by caring for our bodies and buying insurance. And it permits some stratification of medical care on the basis of wealth (though it softens this inequity by promoting evidence-based practice for all).
In the wake of September 11, 2001, and again after Hurricane Katrina, many Americans hoped to restore a spirit of shared sacrifice and mutual support. More able leaders might have brought us closer. But barring a catastrophe much more severe than that of 9/11, a return to a World War II ethos isn't likely. What is possible is a new reciprocity of personal and public commitment, tailored to American self-reliance and the uncertainties of a global economy. This arrangement stands a decent chance of delivering near-universal coverage. Success could cement a new understanding of government's role — not as a guarantor of easy living irrespective of striving but as an insurer of basic decency when self-reliance fails.
These ideas will disappoint proponents of more sweeping reform aimed at achieving uniformly generous coverage for all. link link
But this strategy responds to the anxieties of working Americans, who accept that they must, in the main, depend on themselves. It supplies a safety net when self-reliance falters because of large economic and social forces. And it shields the poor from the degrading, life-endangering consequences of going without basic care because they cannot pay for it. It calls on all of us, though, to take greater personal responsibility for our health, by caring for our bodies and buying insurance. And it permits some stratification of medical care on the basis of wealth (though it softens this inequity by promoting evidence-based practice for all).
In the wake of September 11, 2001, and again after Hurricane Katrina, many Americans hoped to restore a spirit of shared sacrifice and mutual support. More able leaders might have brought us closer. But barring a catastrophe much more severe than that of 9/11, a return to a World War II ethos isn't likely. What is possible is a new reciprocity of personal and public commitment, tailored to American self-reliance and the uncertainties of a global economy. This arrangement stands a decent chance of delivering near-universal coverage. Success could cement a new understanding of government's role — not as a guarantor of easy living irrespective of striving but as an insurer of basic decency when self-reliance fails.
nejm, 19.09.07
1 Comments:
excelente post.
Os EUA estão a chegar à conclusão que o investimento num sistema de saúde universal significa importantes vantagens para a economia.
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