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You Can Get There from Here: Mapping the Way to a Transformed U.S. Health System

Karen Davis

In a speech he gave nearly half a century ago, John F. Kennedy noted that the Chinese symbol for crisis comprises the characters representing both danger and opportunity. Today, his observation could not be more relevant. The potent combination of recent events in the United States has presented the nation's leaders with a historic opportunity to fix our broken health care system.

With 116 million adults under age 65 reporting health care-related financial issues, the nation's health care crisis and economic crisis have become inextricably intertwined. As unemployment grows, more Americans will join the ranks of the uninsured. States under pressure to balance their budgets are already making cuts in health programs that serve low-income adults and children. Already families—even those with insurance—are struggling to pay their share of premiums and medical expenses. Two-thirds of all adults under age 65 report being uninsured or underinsured, forgoing needed care, or struggling to pay medical bills or accumulated medical debt.

Ours is the only industrialized nation that fails to ensure that all its citizens have access to affordable health care. We are slipping further behind what other countries achieve with their more modest investment in health care: the U.S. now ranks 19th out of a group of 19 major industrialized countries on an important measure of health system performance: mortality amenable to medical care. If we did as well as the best-performing countries, we would have 100,000 fewer deaths each year.

Access is not the only problem. The poor performance of the U.S. health system also adds to the economic crisis. Currently, the United States spends twice as much per person as other major industrialized countries, saddling American businesses—especially those with aging workforces—with high expenses. It adds to burdens on taxpayers and squeezes other public priority needs, from education to the nation's aging infrastructure.

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Publication Details



K. Davis, You Can Get There from Here: Mapping the Way to a Transformed U.S. Health System, The Commonwealth Fund, January 2009.