Intended for healthcare professionals

Rapid response to:


Uninsured Americans and the new Democratic Congress

BMJ 2006; 333 doi: (Published 30 November 2006) Cite this as: BMJ 2006;333:1134

Rapid Response:

Universal Cover for America?

Dr. Uwe E Reinhardt writes in “Uninsured Americans and the new Democratic Congress: Is universal coverage now more likely?” "...America's national conversations on the topic - a conversation that resembles nothing so much as the rambling of a drunken lover at a bar - big talk, little action. In health care it has become "the American way."

Be still my heart!

While Dr. Reinhardt cites Altman's Law as the main reason for lack of change in financing America's healthcare mess, I do believe his other issue is at the heart of the matter.

America and Americans simply do not have any sense of "health solidarity" and this does stem from the belief that poverty is “the product of free choice rather than lineage and bad luck.”

While Americans don’t have a concept of health solidarity, many in the healthcare clinical and financing professions will claim the right of “emergency care” for all Americans. Unfortunately, this manifestation of "guaranteed access to healthcare," e.g. being wheeled into the emergency room with end stage bone cancer, isn't a very effective way of providing healthcare.

The challenge for American healthcare reform isn’t necessarily developing a sense of solidarity or political expedience, but rather economics. The current health care financing scheme (or lack of) in the US is increasingly putting us at a disadvantage in the global economy. We're just too inefficient. Not too expensive, just too inefficient.

Couch the conversation in economic and competitive terms and watch American politics at work.

Competing interests: None declared

Competing interests: No competing interests

28 November 2006
Hank Kearney
PHM International, US 32958