How Should Health Care Be Organized?

Health care is one of the most complex, controversial and debated aspects of American public policy. It is a term that encompasses many different topics, but at the core, it refers to the efforts of trained professionals and lay people to promote and maintain physical, mental, and emotional well-being. The United States spends more on health care than any other country in the world. Total health care expenditures in the country in 1991 topped $666 billion and made up over 12 percent of the nation’s gross domestic product (GDP), double what they were in the 1960s.

People have a variety of views on what health care should look like, but the broadest view is that it should be affordable and accessible for everyone. Some believe that healthcare should be treated as a consumer good, like blenders or oil changes, which some can afford and others cannot, with the government acting as a middleman to ensure that no one goes without basic medical care. Others believe that healthcare is a right that the government has a moral obligation to provide for all.

Still others think that healthcare should be allocated based on efficiency, to get the best “bang for the buck.” The theory here is that healthcare decisions should be weighed and judged according to the maximum benefit for the greatest number of people.

Some people also take the view that healthcare should be subsidized to allow as many people as possible to access it. The idea is that if people are guaranteed healthcare, they will be more likely to take better care of themselves by exercising, eating healthy and avoiding dangerous behaviors such as smoking and drug abuse.

Other people believe that a free market should be allowed to operate in the healthcare sector, as it does in other industries. This view suggests that consumers will become smart, efficient, thrifty users of healthcare by experience, learning and growing while purchasing it from a wide array of providers who offer outstanding quality and various price options.

There is, of course, no right answer to the question of how best to organize healthcare. Each country has a system that meets its own needs. The US, for example, has a mixed private/public system with more privatization than most other countries in the developed world. Most doctors and nurses work for private companies rather than the government, and many patients have health insurance that they buy themselves or through their employers.

The biggest issue, however, is the rapid growth of health care costs. The rate of increase far outpaces that of any other goods and services in the economy, leading to a prevailing opinion that health care is not cost-effective. Attempts to curb the problem have produced some institutional, administrative and regulatory innovation, but the results have been mixed at best. The growth of costs continues, and many Americans feel that their faith in healthcare professionals and the non-profit providers of health insurance and benefits is being shaken.

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