Health Reform in the USA: Is It Time Yet?
SCOTT C. RATZAN
In 2007, the quest for the next president of the United
States has begun in earnest. Nearly 20 candidates have articulated their
intention to campaign to be elected president in 2008.While the campaign
agenda addresses the concerns of most Americans related to the political
issues in the world, no candidate can ignore the qualms Americans have
with their health care system.Many Americans believe their health system
is the best in the world, but the World Health Organization (WHO) rankings
in 2000 placed the United States at thirty-seventh.If these rankings
were repeated, with the criteria for ranking based on three principle
areas of good health, responsiveness, and fairness in financing, it
is doubtful that the United States would have improved.And, with an
estimated nearly 45 million to be uninsured during the election campaign,
along with a system outpacing inflation in costs and weakening in perceived
quality, it is no surprise that each candidate has made health a central
tenet to his or her campaign.
Even President George W.Bush, in his recent State of the
Union speech, urged
Congress to look past ‘‘pure politics ’’and seriously
consider proposals to give more
Americans access to health insurance by taxing many employer-sponsored
health
insurance plans and by giving tax breaks to people who want to buy insurance
as
individuals.
While the federal candidates debate, state officials are
acting:In Massachusetts, former governor and Republican presidential
contender Mitt Romney joined with a Democratic legislature to implement
the nation ’s first statewide universal coverage plan.In Oregon,
legislation has been introduced to reform a system of insurance developed
before World War II that linked employers and health insurance, eliminating
the employer and requiring purchase of health policies directly from
insurers. And, in California, the nation’s most populous state,
Governor Arnold Schwarzenegger is pressing for a plan that would ensure
coverage for the state ’s uninsured.
In fact, ever-growing voices from a multitude of factions
are expressing the need for universal health care coverage.A multistakeholder
group with private sector, civil society, and health care providers
presented a plan to reform the system and provide universal health insurance.
Such rhetoric has been absent from the national political stage for
more than a decade.
Clearly, the health issue is becoming higher profile.
However, without a comprehensive review and reform that extends beyond
financing to delivery of care; prevention, detection, and treatment
of disease; legal/malpractice reform; innovation in research and health
care delivery; quality of care; performance measures of hospitals, doctors,
and health care providers; communication technology (e-health); among
others, the system as we know it will not deliver the quality health
care we endeavor, nor the promises that are part of any political campaign.
One such process that can offer opportunity in any case
is the renewed effort to set goals and national health objectives for
American’s health that can provide the basis for coordinated public
health action on the national, state, and local levels. Since 1979,
the U.S. Department of Health and Human Services has developed and published
a comprehensive set of public health objectives.The most recent ones
were called ‘‘Healthy People 2010.’’ This initiative,
led by the federal government, has involved partners from many different
backgrounds, such as public health experts; health care providers; state
and territorial agencies; organizations representing professional, advocacy,
and business sectors; and citizens. Ideally, the notion that developing
these with multiple parties while setting and monitoring progress should
motivate action.
The new ‘‘Healthy People 2020’’ under
development suggests four important health objectives:
1. Promote optimal health in order to reduce preventable
death, illness, injury, and disability.
2. Eliminate health disparities based on race, ethnicity, socioeconomic
status, gender, geographic location, sexual orientation, and related
factors.
3. Make wellness a way of life and assure that all people have the knowledge,
skills, and opportunity to make healthy lifestyle choices.
4. Serve as a focal point for collaborative action on the local, regional,
national, and international level.
These are important objectives for the ‘‘public’’
health system and should be embraced with engagement during the process,
but most health care is delivered outside of the ‘‘public’’
or in a ‘‘system.’’ Some of the current health communication
work is recognized as a chapter dedicated to the applied aspects of
the field. Communication should not be relegated to certain areas, however,
but should be integrated in all of our health activities. In the future,
health communicators can develop a central role in health. If we are
able to improve communication, adding an evidence-informed approach
for our policymakers, and an evidence-and ethically-based approach for
each of us to make health decisions as health competent consumers, we
all will be one step closer to improving health care at all levels in
the plight for the goal of a healthier tomorrow.
_____
Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal of
Health Communication: International Perspectives. He also serves
as Vice President, Pharmaceuticals and Global Heath for Johnson &
Johnson.
