Article   |   Volume 159, Issue 6

Restoring Health to Health Reform: Integrating Medicine and Public Health to Advance the Population’s Well-Being

By
Lawrence O. Gostin, Peter D. Jacobson, Katherine L. Record & Lorian E. Hardcastle

June 2011










It is hard to overstate the intense political and media attention given to health care. New medical discoveries and technologies are front-page news stories. In many communities, health care is either the largest or a substantial employer, and rising employee health care costs are a major concern for individual families and employers alike. That we, a wealthy society, invest more in health care than in subsistence goods signifies the value we place on high technology and specialized health services. The United States spends nearly 17% of its gross domestic product (GDP) on health care (a combination of public and private financing), or over $7000 on each American annually. This amount of health care financing is nearly double the investment made in any other highly developed country. As such, economic and political factors explain the salience of health care in American society.

Given the expansion of the health care enterprise, it is not surprising that the American political community is deeply focused on it. For a generation, health reform has been a dominant domestic political issue. The nation recently went through the politically grueling passage of the first comprehensive health care reform since the 1960s, with cavernous political divides on the role of government in financing and delivery of care. Critics portrayed modest proposals for cost-effectiveness comparisons—routinely accepted in other advanced democracies—as “death panels,” and the final law inhibits the use of quality cost-effectiveness analysis in coverage, reimbursement, and incentive structures. Within weeks of the law’s passage, twenty states filed lawsuits challenging the constitutionality of the individual mandate—a fundamental component of the reform. Restoring Health to Health Reform: Integrating Medicine and Public Health to Advance the Population’s Well-Being - PennLawReview.com