Introduction

Why health care? Why change?

Let's face it. Our health care system is sick -- 1 IN 6 Americans has NO HEALTH INSURANCE. 1 IN 3 is OBESE. 7 OUT OF 1000 NEWBORN BABIES DIE in infancy. We have a health care system that costs us 16% OF OUR GDP (expected to rise to 20% by 2016), the most expensive in the world, yet it's ranked 37th by the WHO, behind countries like Chile and Costa Rica, and right before Slovenia. And we are the only nation in the developed world WITHOUT UNIVERSAL HEALTH COVERAGE.

We’re ready for change, but we can't decide what we want. We look to Canada and its universal health care system, but wince at the notion of having to queue up for services. We think getting free government services, like the British NHS, is a nice idea, but we’d hate to have our choices limited in what kind of care we get. Our health care system reflects the principles that this country has always celebrated -- individual freedom, personal choice, diversity, and equal opportunity. In short, here in America, we think that we should all have the chance to get whatever we want, however much we want, whenever we want it.

While we’re freely consuming health care services, our health care system is bursting at the seams. With the graying of the Baby Boom generation, many believe that Medicare is set to go bankrupt before another generation reaps its benefits. Medicaid now pays for the majority of long-term care costs in the country. Meanwhile, the average worker contributed $3,300 to his or her employer-provided health insurance. Together, public insurance programs pay for over 60% of all health care costs, while the rest comes either out of our pockets or our payroll.

America does do one thing very well – providing us with however much of whatever we want, whenever, granted we (or our health insurance, if we have it) can pay for it. Our hospitals have the best newborn- and elderly intensive care technologies in the world. We have specialists for every disease and body part imaginable. Our doctors can transplant anything from hearts to livers to skin. We're constantly investing R&D on new drugs and unexplained diseases processes. And as America ages, we now have more diseases that we manage than fight. These "magic" interventions would most likely be only dreamed of anywhere else.

But for the one in six uninsured Americans and the many more under-insured, however, reality is very different. They are most likely racial/ethnic minorities and immigrants working in low-wage jobs, who are already dealing with other challenges. Uninsured patients wait until the last possible minute to seek care for illnesses ranging from bad colds to cancer and serious infectious diseases. Care is not given in doctor’s offices or hospital visits, but in the emergency room, often with poor outcomes and at high costs.

This blog was inspired by a class of Stanford undergraduates studying comparative international health policy in the winter of 2008. It’s organized by relevant topics in health care and policy (seen as “labels” to the right), along with some thoughts and questions to get started. While these tend to be the most recurrent themes in health care policy debates, please let me know other topics that you think I’ve neglected, as well as if you'd like to be a co-author of this blog. Most importantly, this blog is meant to be a forum for all of our comments, entries, resources, and ideas.

CHANGE BEGINS WITH CONVERSATION. So let’s talk.