This week I had an interesting conversation with my son. A college senior, he’s considering job options in his field of environmental science. Possibilities include various types of nonprofits, research, and environmental education organizations. 
As we talked about his ideas, and he does job interviews and gets offers, he is asking about health insurance.
Notably most organizations tell him that’s up to him. So here is the son of a physician executive, successfully launching into the workplace, with the strong prospect of not having health insurance.
As you know, I believe that we need to take a hard look at how health care is managed and funded in this country. The current system is way too complex, saddled with very high administrative costs, delivers care in uneven and illogical patterns, and leaves some 47 million Americans not covered. Here are three key problems I see:
- Government promises more benefits than it is willing to pay for, and passes the uncovered costs to private health insurance
- The health care payment structure is set up to reward visits to multiple doctors and lots of tests rather than coordinated and planned care, especially for chronic illness.
- Access to care is different depending on where you live and what kind of insurance you have, if you have any.
A recent New York Times has a great essay illustrating the problems of multiple tests and doctors http://www.nytimes.com/2008/03/11/health/views/11essa.html?ref=health
And if you're following politics and would like to read some outside analysis of each presidential candidate's health care reform policies, check out the Commonwealth Fund, a private non-profit that works on health care policy analysis. http://www.commonwealthfund.org/
You can also access information on this site about the health of populations in the United states, by individual state http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=494551
The information on Vermont is very up to date, identifies Vermont as the third healthiest state in the country. It also confirms the clear evidence that the most cost effective health systems in the world and in the US are primary care based with high levels of generalists and low numbers of specialists. By US standards Vermont is high in generalists, low in cost, and has excellent outcomes. By international standards we have a long way to go.