Health care shows up on the political agenda in 2 very different ways, as a social issue and a budget issue. These 2 views prompt very different sets of questions and also shape how the 2 major political parties focus their respective efforts in the health care arena.
Viewing health care through the lens of a social issue prompts such questions as: What policies would best improve the population’s health? How can report cards be used to improve the quality of surgery? Where are there opportunities for additional disease prevention? The questions here are intricate and detailed. Some of the issues are clinical, and advice from physicians is actively sought and welcomed. For example, no one would develop a pay-for-performance system for surgeons without extensive involvement of the relevant surgical societies. Other issues are environmental, and physicians (unfortunately) have had less to say. Despite the important role of physicians in encouraging smoking cessation and reducing unnecessary prescriptions of opiate medications, in terms of policy efforts to reduce tobacco consumption and cut back on addictive medications, the physician community as a whole has mostly ceded this work to public health specialists. Still, the goal in both disease management and public health is squarely on health as the important outcome.
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David Cutler, PhD David Cutler, PhD, is the Otto Eckstein Professor of Applied Economics in the Department of Economics and holds secondary appointments at the Kennedy School of Government and the School of Public Health at Harvard University...