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The history of U.S. health care in about 1,000 words

“All men are created equal” may be the guiding legal principle for citizens of the United States, but not when it comes to health care coverage and outcomes, says Victor Fuchs, PhD, one of the nation’s foremost health economists and the Henry J. Kaiser Jr. Professor, Emeritus, at Stanford.

In a Viewpoint published today in the Journal of the American Medical Association, Fuchs provides a history lesson on how and why the U.S. health care system spends more than double on per-person health expenditures than other advanced nations, and he offers some strategies for controlling future costs.

“This is the best short piece on U.S. health care that I’ve ever seen,” Howard Bauchner, MD, editor-in-chief of JAMA, told me.

Beginning today, the Affordable Care Act expands the number of Americans receiving preventive care, providing new federal funding to state Medicaid programs that choose to cover preventive services. It also requires that states pay primary care physicians no less than 100 percent of Medicare payment rates for primary care services.

While the health-care reforms mandated in the act include some provisions to motivate health-care providers to become more efficient, less fragmented and more accountable, it doesn’t include revenue sources for all its new services. Fuchs says, “More comprehensive reforms are necessary to avoid financial disaster.”

According to Fuchs, there are three fundamental differences in the U.S. system — driven by its history — that make it difficult for the U.S. to adopt a less costly government-financed health care system. There is a distrust of large government that began when America broke away from the strong-armed British Empire. There is a reluctance to redistribute wealth across all citizens, in part because of the country’s cultural diversity. And there are “choke points” in the U.S. political system — such as the cost of election campaigns and the Senate filibuster — that give deep-pocketed special interest groups the upper hand in preventing sweeping reforms.

As a new Congress returns to work with health care reform high on its new year’s resolutions, Fuchs’ editorial provides a starting point, grounded in history, for a new round of negotiations.

Previously: Study: If Americans better understood the Affordable Care Act, they would like it more, Does the Affordable Care Act address our health-cost problem?, Stanford economist Victor Fuchs: Affordable Care Act “just a start” and An expert’s historical view of health care costs

From Dec. 24 to Jan. 7, Scope will be on a limited holiday publishing schedule. During that time, it may also take longer than usual for comments to be approved.

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