Health care in America must be a right, not a privilege.
I hope the new health care exchanges created under the Affordable Care Act will provide some help.
The country has large unfunded liabilities - social security, health care, and there will have to be some adjustments to these problems. What is scary though is how much worse things have gotten in the last eight years, and the Iraq war is one of the main factors.
The national debt will have increased by approximately 50% in just eight years! We will have created a new unfunded entitlement - disability and health care benefits for the huge number of disabled veterans returning from the Iraq war.
The German health care system is unique in its attempt to combine competition among sickness funds on the one hand and a universal coverage plan on the other hand. Most health care systems are either one or the other, so you either have private insurance and competition but not everyone is covered for everything, or you have a single-payer system. So the ideal types are like the American system on the one hand or the Scandinavian or U.K. systems on the other end. Germany tries to combine the advantages.
The quality of health care in Germany is not as good as people sometimes believe it to be. We have problems with chronic diseases. The German system allows too many hospitals and specialists to treat chronic diseases. We do not have enough volume in many institutions to deliver good quality, and we do have fairly strict separations ... between primary physicians, office specialists and hospital specialists. But I think the quality problems can be solved in the next couple of years, and we have made major progress in diabetes, coronary artery disease and pulmonary disease care.
I think from an economics point of view, it is important that the money that is spent for health care is well spent - what is the cost-effectiveness of the money that is used? - because if the money is well spent, many people benefit from the system, and it is also a good market for finding employment. I do not see a reason why we should limit ourselves when it comes to very qualified and humane employment opportunities if there is no waste and if there is medical need.
In comparison to the U.S. health care system, the German system is clearly better, because the German health care system works for everyone who needs care, ... costs little money, and it's not a system about which you have to worry all the time. I think that for us the risk is that the private system undermines the solidarity principle. If that is fixed and we concentrate a little bit on better competition and more research, I think the German health care system is a nice third way between a for-profit system on the one hand and, let's say, a single-payer system on the other hand.
The good things at the U.S. health care system are that we have a well-trained labor force, particularly physicians; I don't think any nation trains doctors better. We have the latest technology, simply because we throw so much money at it. We are really technology-hungry in this country. That's a good thing. Our system more treats patients like customers, which is a good thing; that it's very customer-friendly. And it's very innovative, both in the products we use, in the techniques we use and the organizational structures we use. Those are all very good things, highly competitive.
The bad things the U.S. health care system are that our financing of health care is really a moral morass in the sense that it signals to the doctors that human beings have different values depending on their income status. For example, in New Jersey, the Medicaid program pays a pediatrician $30 to see a poor child on Medicaid. But the same legislators, through their commercial insurance, pay the same pediatrician $100 to $120 to see their child. How do physicians react to it? If you phone around practices in Princeton, Plainsboro, Hamilton - none of them would see Medicaid kids.
We Americans, or half of Americans, think health care is a commodity. Other countries view health care as a social service that should be collectively financed and available to everyone on equal terms. My wife and I just interviewed the German minister of health, and it was an exhilarating experience, because it was a totally different language. It was obviously important that everyone should have the same deal in health care.
The American people are not ready for the idea that everyone has at least a moral right to good, timely health care. They do agree they have a moral right, in critical cases, to have anything done to save their life, but they don't believe that anyone has a right not to fall that sick to begin with. So if you ask me, "Are we ever succumbing to some notions of solidarity as a nation?," I would say, "Not at all." I would describe us as a group of people who share a geography. That's a better description of Americans than that we're a real nation with a sense of solidarity.
If you want to look at a purely socialized health care, you would have to go to the United States, where we have it. In particular, that's the system we reserve for our veterans. So if I hear politicians run down socialized medicine - and I have done that before the Congress - I say: Do you hate your veterans? Why do you reserve purely socialized medicine - there's only the U.S. and Cuba that have that - for the veterans? So getting the terms right would be very, very helpful in our national conversation on health reform.
Let's get put in place a better health care system the American people deserve.
When a health policy analyst went to heaven, he asked God the same question: 'Will America ever have a single-payer system?' And God said, 'Absolutely. Just not in my lifetime.' I'm afraid that little story is true. Americans just are not prepared to let government be responsible for all of their health care.
The bad things are that our financing of health care is really a moral morass. It is a moral morass in the sense that it signals to the doctors and hospitals that human beings have different values depending on their income status.
We have a nation where the elite thinks it's OK to advocate a war and send the lower-income people to do the fighting. It's natural for such a people to think that the lower-income people should also have a worse health care experience. And the other countries are not there - I always say, not there yet. I tell the Germans and the Swiss, "You're not there yet, but if you're not very, very careful, if we Americans come over there and rearrange ... your health care system, you will be just like us."
Everybody should have health care, on the one hand. But on the other hand, if you ask Americans, "Are you willing to pay for it?," they say no. So I've never been able to understand this contradiction.
There are libertarian values which say private property is the overarching value, the sanctity thereof, and there are egalitarians who say health care should be shared and so on. That's fair enough.
Winning slowly is another way of losing. Americans are screwing up our health care system again right now. That's going to cause grave trouble for people over the next five, 10 years. There are going to be lots of people who die, lots of people who are sick. It's going to be horrible. But 10 years from now it will not be harder to solve the problem because you ignored it for those 10 years. With climate change, that's not true. As each year passes, we move past certain physical tipping points that make it impossible to recover large parts of the world that we have known.
I think the gap between the rich and the poor is a dangerous phenomenon in Russia and it needs the attention of the state. The only reasonable way to correct the situation today is not to go after big businesses, but to give breathing room to medium and small businesses. That means protecting citizens and small entrepreneurs from arbitrary rule and from corruption. It means investing the revenues from the national natural resources into the national infrastructure, education and health care. And we must learn to do so without shameful theft and embezzlement.
Space is our tool to take care of the world. From space, we know the Earth is fragile, and we can follow oil spills and forest fires, and monitor the environment and save it. The needs of remote communities and the needs of astronauts are similar. Canada is a country that is big and has a lot of people living in faraway places. Physicians in remote areas need to have contact with more senior colleagues. We depend on telehealth for advice, X-rays, labs. At the most simple technical level, space technology contributes to remote health care.
I'm trained as a medical doctor - that's my field: I've been practicing long enough to see how extremely broken our health care system is, how broken our health is, the link between that and the environment.
You don't know what the real problems of a health care system are until you get sick.
I don't support ObamaCare and see it as a step backward that entrenches the power of the private health care industry.
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