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Recently a pre-med WWAMI student asked me, “Why is there so much disagreement about health care in the U.S.?” The question haunted me, and I began to consider how complex the question was.

Why is U.S. health care so sub-optimal compared to other advanced societies? Nations continuously grapple with policy changes, but the under-performance of our health care system should be concerning to every existing American.

Meaningful health care reform resides in a circle of shifting culpability for failure among stakeholders. Insurance companies are responsible for barriers to equitable health care and administrative waste. That drives excessive costs without measurable benefits of quality of care. Drug and device companies use federally funded research, and then market those resulting products at exorbitant prices. Many physicians and hospitals focus on volume of procedures over the value of personal hands on diagnostic and therapeutic care. Medical trainees are attracted to high-paying specialties when the undersupply of primary care physicians is in a current crisis.

Many U.S. citizens have chosen health-related behaviors that push them into costly care and poor outcomes. Most chronic conditions result from modifiable lifestyle behaviors that depend on prescription drug solutions rather than better self-choices.

Defensive medicine is fueled by fear of litigation with ordering unnecessary, wasteful medical services. Many physician choices focus on testing rather than on evidence-based decision-making.

After considering some of the complexities, I came to realize overall culpability for our market-driven health care inadequacies and inefficiencies should be shared by every stakeholder in the current system. Reaching for good policy, lawmakers are diverted from rational health care legislation by health industry stakeholder lobbyists.

The achievable objectives of unrestricted accessibility to comprehensive coverage, and free choice of physicians and hospitals is currently, and will continue to be, politically stymied - unless it is corrected by expanded and improved Medicare for all.

Richard A. Damon,

Bozeman

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