Photo: Leslie Williamson
Dean Philip A. Pizzo, M.D.

Letter from the Dean

Dear Readers,

I often wonder, what will it take for the citizens of the United States to demand quality health care for all Americans? How far will our current system of health-care delivery have to spiral out of control for America’s citizens to finally demand something better?

Our current system is so mediocre that it ranks 37th in a World Health Organization study of health-care system performance. The problem certainly isn’t that we spend too little on health care. In fact, the United States spends more on health care per capita than any other nation on the planet — more than 15 percent of our gross national product.

So what is it? Why is America’s health-care system performing so poorly on this global scale — and do we really even have a health-care system?

Consider some facts:

  • Health insurance premiums have reached extraordinary heights. The increasing cost has created a crisis for employers and individuals alike. Detroit’s General Motors cites soaring health-care spending as the leading factor undermining the company’s global competitiveness. Health-care costs now account for $1,400 of each vehicle’s price tag.
  • Largely because of rising costs, our uninsured population is substantial and is growing. One in 7 Americans is currently uninsured. The total is increasing at a rate of 100,000 people a month. Moreover many other citizens are suboptimally insured. According to the Institute of Medicine, lack of coverage is responsible for the deaths of 18,000 people each year.
  • The system’s deficiencies erode the public’s trust in medicine. The recent debacle surrounding the availability of the flu vaccine, which revealed how tenuous our supply line for vaccines can be, surely has shaken the public’s trust. So too have the revelations of potential health hazards of drugs that the public had embraced (e.g., COX-2 inhibitors such as Vioxx).

It’s hard to fathom why our nation, with its great financial and intellectual capital, has a health-care system that’s so far from world class. Much of the trouble comes from the belief that health care must be run like a business — as if personal health were a commodity. This notion, promoted over the past two decades by our leaders in Washington, posits that the free market will restrain costs and bring high-quality care to all. Obviously, this strategy has failed miserably.

I do not believe that modifications around the edges of our health-care quagmire are going to do it. We need sweeping change. I personally favor a single-payer model incorporating support for medical training, innovation and discovery. But I’m not convinced that our political leaders can muster the will to overcome the obstacles from special interests with stakes in supporting the status quo. This reality means other options must be considered.

Perhaps it’s at the local level where true reform must take shape. Oregon, with its inclusion of the uninsured in its Medicaid program, has been a leader in this area. California could follow suit if the legislature passes a bill, to be reintroduced this year, that would insure Californians under a single-payer plan. One thing is clear to me. We need more pioneers and innovators.

This issue of Stanford Medicine takes a look at America’s struggle for health-care reform. You’ll hear from six leading health-policy experts posing some possible solutions to the crisis. You’ll also learn about recent reforms in Medicare and Medicaid that its chief, Mark McClellan, MD, PhD, believes change the paradigm. And Jan van Lohuizen, President Bush’s principal pollster, will share some thoughts on what Americans are thinking about health care.

I hope you’ll find the magazine not only thought-provoking but that it will move you to take action.

With best regards,

Philip A. Pizzo, MD
Professor of Pediatrics and of Microbiology and Immunology
Carl and Elizabeth Naumann Professor

Dean, Stanford University School of Medicine

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