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Doctors must lead America's healthcare reform

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.334.7594.608-a (Published 22 March 2007) Cite this as: BMJ 2007;334:608

Last week's JAMA dedicated most of its pages to America's broken healthcare system, particularly the desperate problem of poor access to care. While costs are at an all time high, around 60 million Americans are uninsured or underinsured, and a cluster of papers and comment articles describes the consequences for their health and wellbeing: For people with heart attack, poor coverage means inability to pay for drugs and other essentials, worse angina, worse quality of life, and a higher risk of readmission (pp 1063-72). The story is the same for people who fall ill with chronic diseases or injure themselves in accidents (pp 1073-84). Emergency departments across the country are “at breaking point” trying to deal with a flood of people who have nowhere else to go for the care they need (pp 1128-30).

The multitude of reforms on the table tinker with infrastructure, insurance eligibility, or tax breaks. But a leading article says none of them will be enough to fix a system so complex and fragmented that even experienced doctors struggle to navigate their patients safely through it.

Radical change is needed. And doctors must be in the lead, write two commentators. The profession must unite in driving reforms away from cost cutting and short term fiscal competition and back towards the patient (1103-11). Only when the system is focused clearly on value for patients (not profits for insurers, hospitals, or anyone else) can it begin to heal.

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