Healthcare in the US: Restating the Problem

The following is from a longer piece by Dr. Jeffrey Lieberman (MD) of Columbia University.  The entire address is on Medscape (see footnote), but I thought these paragraphs explain the current healthcare mess with brevity and precision.  The passage is unedited.

What should be done? I am not a politician, I am not a legislator, I am not an economist. I am a physician, but it seems to me that this is not rocket science. This really is something for which common sense could articulate the questions and develop a way to answer.

The first question is, is healthcare a right or is it a commodity? If it is a commodity, then you get what you pay for. If it is a right, then everybody deserves it. If it is a right, then it is the government’s responsibility to ensure that everyone deserves it. If that is the case, as was suggested with the passage of the Medicare and then Medicaid legislation, then how much is the government prepared to spend? How do we in a society want to spend? Is it 5% of our GDP? Is it 25% of our GDP? That determines how much money we can spend on delivering healthcare to the entire population.

This then needs to be translated into an infrastructure, work force, and financing system that will enable this care to be provided at whatever level we as a society, represented by our government, have determined should be done. What are the benefits and what are the limitations? Are we going to give everything possible to everyone through end-of-life care or are we going to have to ration it?

This is not an unprecedented situation; other countries have dealt with this already. There are single-payer systems, there are single-provider systems, there are hybrid systems. There are nonexistent healthcare systems. We really have a default system in which nobody has taken the responsibility to try to develop something in an enlightened fashion, and the result is what we have, which is not working.

Another issue that must be considered in any serious approach to try to deal with healthcare has to do with how we view biomedical research and the advances that it provides. The real solution to disease care cost is through research which provides, ostensibly, a better understanding and better treatments—and, ultimately, cures for illness. We have seen this over history how scientific breakthroughs lead to medical innovations that lead to reduction of disease and mortality, reduction in cost, greater productivity, longer lives.

Right now, we barely fund biomedical research.

My comment:  The Affordable Care Act and Trumps AHCA were both band-aids rather than solutions to fundamental problems.  Both sought to make the current mess more livable rather than actually fix anything.  Now, Trump’s budget proposes cutting funds for medical research to use for the border wall, which pushes any possible solution further into the future. While one might question whether spending on medical research is correctly prioritized, moving money from there to concrete in a desert solves nothing.


  1. Jeffrey A. Lieberman, MD, “‘I’m Mad as Hell!’: Healthcare in America Today,” Medscape, 28 March 2017.

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