By John Geyman, M.D.
March 15, 2017
Excerpts from the Preface
There is widespread acknowledgement today that our current health care system is dysfunctional and broken, and I believe that we have reached a crisis point in U.S. health care. We need to better understand why this has come to pass if we are to avoid continuing in the same directions. The sixty years we will discuss have had many policy choices in how we finance and deliver care in this country.
It is still a pervasive myth that U.S. health care is the best in the world – part of the American exceptionalism argument – but, as we will see, this is far from the case. Technology does not necessarily make things better, and we will look at how the traditional values of medicine as a profession have held up over the years.
How our health care system is organized and conducted should be above politics as a non-partisan issue, but we know that that is certainly not the case today nor has it been in earlier years. Despite ongoing national debates, we still have been unable to answer, as a society, even the most basic questions about health care, such as – Should we establish universal access to care for all Americans? Should health care be for-profit or not-foe-profit? Is health care a right or a privilege based on ability to pay?
The results of the 2016 election cycle, which turned over the White House and both chambers of Congress to the Republicans, has placed our already broken health care system in continuing crisis.
This book is organized in three parts. Part One includes reflections on system changes over sixty years. Part Two, then and now, gives my personal perspective from direct experience over those sixty years. In Part Three, todayās realities are described, as are lessons that can be learned from the evolution of health care, three major alternatives for financing health care, and projections for future health care reform.
As the ongoing debates over the future of health care continue across the political spectrum, I hope this book is of use in cutting through the smoke and mirrors to the basic questions we still need to answer. Although the health care establishment may appear to be too imposing to be amenable to change, we have well documented evidence over the years that this most expensive system in the world compares poorly with other advanced industrialized countries in access, cost, quality, equity, and outcomes of care. We have had pro-market forces well entrenched for more than three decades that want to preserve deregulated markets that serve corporate interests more than patients and families. How to reverse that in the public interest is a matter of education and political will.
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Comment:
By Don McCanne, M.D.
Our health care system is designed to serve first the market stakeholders and only secondarily the patients. John Geyman explains to us the history and flawed policy decisions that brought this about. As an icon in family medicine, both in patient care and in the academic arena, he adds his invaluable personal experiences to provide us with a crystal clear picture of what is wrong and what we can do about it – finally placing patients first, where they belong.
This book is particularly timely since it is becoming more obvious to the nation that the modest changes under the Affordable Care Act were grossly inadequate, and that the Republican promises that health care would be much better and much less expensive under repeal and replace have represented nothing more than deceptive political rhetoric as it is clear that their replacement proposals would only compound the problems and deficiencies of our system.
John Geyman shows us that we must move beyond the debate over only two options – continue with the current deficient system under ACA or modify it through detrimental reductions in funding and regulatory oversight. We should be able to recognize the mess that we are in and how the third option – a single payer national health program – would take us out of this quagmire. A national health program is inevitable. We should make the move now while the glaring deficiencies are front and center on the national scene and highly visible to all.