Is there a health care system? In a word, no. I find myself chuckling internally whenever I hear politicians talk about reforming our health care system. In the United States, we have a patchwork quilt that is barely stitched together with an incredible variety of rich resources, absent resources, good insurance, lousy insurance, no insurance, and providers of care that provide good quality and poor quality. In fact, for the price we pay, we have the most expensive health care in the world with performance that is only fair.
For $5,700 per person per year, the performance of our health care “system” scored 66 out of a 100 on international review of health care outcomes. click for reference 14 countries perform better than the United States in death rates for diseases considered treatable by healthcare, and all at lower-cost than we do. We spend an enormous amount of money on end-of-life care and elective procedures that provide small benefits to people, while not adequately using preventive strategies and effective care for the chronically ill. 
Doctors are frustrated with lack of payment for things that could make a big difference, like effective systems to care for chronic illness. Employers are fed up with the high cost of health insurance, and their subsidy of government underpayment for the cost of health care services. Yet this issue has not reached the top of the list of topics that Americans consider important politically. And it’s a very hard topic to discuss in a “sound bite.”
But there is absolutely no system. The quality and availability of healthcare varies by family, employer, city, state, health care facility, physician group, and a variety of other factors that are not applied according to need. In my view it’s really unethical, and screams for standardization and the building of a real system. Is it fair that if you’re a child of a family that’s unemployed you have a different health system than that a child of a family that has employment? Fortunately, here in Vermont, it’s very hard to be a child without insurance. But that’s not at all true in all states.
Building a system won’t be easy. But neither was building an Interstate Highway system, or sending humans to the moon. First it takes leadership and political will, and then it takes reorganization of the healthcare resources and a more even and fair application of those resources to the interventions that will help the most people.