Let’s First Define the Goals for US Medical Care

Healthcare reform is being widely discussed right now, but the goals of our healthcare system are undefined! What are our actual intended goals for medical care in the US?

Are the goals to improve the population’s health, relieve pain and suffering, and prevent immediate death? Or do the goals also include satisfying everybody’s self-perceived wants to prolong meaningful life as long as possible by all available means? These are very different goals with very different implications for our healthcare system.

Prolonging meaningful life by all available means includes not only treatment with all available drugs and surgical procedures, but also replacing and mimicking all sorts of body-part functions with transplanted organs and artificial devices. That’s a very expensive proposition.

Do our goals include the prevention of all disease? Prevention includes not only immunizations but also the treatment of risk factors for disease, both genetic and lifestyle.  Obesity is just one example of a lifestyle risk factor.

What goals can we afford? And which Americans should benefit from these goals? Only the wealthy and employed – or everyone?

If everyone in this country receives all of the healthcare to which they believe they are entitled today, it could consume the entire US economy. Goal-setting for the US healthcare system should be one of the first topics in this debate about reform.

Norman Makous, M.D.

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