Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
To the Editor: In asking whether US health
care is the best in the world, Dr Starfield1
overlooks a much more fundamental issue: the absence of nationally agreed-on
goals and directions for promoting the good health of our citizens and the
absence of a nationwide system for implementing health goals.
Without clear health policy goals and clearly developed ways of directing
the health care effort in a goal-directed manner, US health care will be determined
by "the invisible hand" of a relatively unregulated health care market that
values efficiency, economy, cost-saving, and the most diluted, adulterated
product that the public will tolerate. These de facto health care goals tend
to promote the financial interests of an industry (health care financing)
in preference to the public's health interest. The false assumption behind
the current adulation of market forces is that an informed "consumer" will
make "rational" decisions and choices about health care coverage and that
bad service will be competitively driven out by good service. However, for
the most part "consumers" do not directly purchase health care for themselves.
It is bought for them by their employers, whose managers are seeking the best
deal, not necessarily the best or most comprehensive coverage.
Collins JA. Deficiencies in US Medical Care. JAMA. 2000;284(17):2184-2185. doi:10.1001/jama.284.17.2184