Why health care reform alone won't make us any healthier

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James Marks may be a doctor, but he's not exactly Dr. Feel-Good. The U.S. health system basically stinks, he says, although he puts it more nicely in his recent post on The Health Care Blog. So don't be fooled when politicians say America's health care is the best in the world, warns Marks, senior vice president at the Robert Wood Johnson Foundation, an independent non-profit focused on improving the nation's health.

Sure, we need health care reform to extend coverage to the uninsured, Marks says. But Marks, a former assistant surgeon general, makes it very clear that regardless of what happens with health care reform, it won't necessarily make us all healthier. After all, no more than 15 percent of preventable mortality is linked to health care, he writes. DailyFinance spoke with Marks about his views on America's health system as well as the recommendations that his foundation believes will actually make things better. Here's an edited excerpt.

DailyFinance:You say it's a myth that America has the best health system. Why?

Marks: We don't have the best health system. There are two aspects to consider. First, you can look at overall health and access to the system. Are we living as long and are we as healthy as in other countries? In both cases, we do poorly.

Second, for those who get to use our health system, especially those with serious illnesses or injuries, do they do as well? We have a very strong health system. But we spend twice as much as many other countries, yet the reviews of the quality of care don't show us as better. This means we're not getting the return on our investment that we should be getting for spending twice as much.

There must be some aspect of our health system that's best?
I'm going to struggle with that. We clearly are a major research engine in diagnostics in treatments, including pharmaceuticals and others. Often, our country is where much of the innovation is developed and tested. I think people with the most serious illnesses can get really terrific quality care if they go to the best places. But most people don't go to the best places. And we have many people who aren't covered at all, so they get diagnosed late.

So won't reforming our health care system make it better and make us all ultimately healthier?
It is not the answer to all our problems. It will help people who don't have insurance and that is a very good thing. But suppose that after the reform, a woman in her 50s with diabetes, who lives in a poor part of the city, gets health insurance that is the equivalent of what a member of Congress gets. She can go to the doctor, learn how to take her insulin, get her kidneys looked at, and become well enough that she doesn't get kidney failure.

But will she also be able to start to become more physically active and watch her diet? She is likely to be going back to a neighborhood where it is harder to find a supermarket. She is likely to live in a neighborhood that is less safe than where a member of Congress would live, making it harder to get exercise. Her disease will get worse quicker. She will have complications, despite having the same health insurance and quality of medical care.

What's the way, then, to really improve our health?
It is about understanding the toxins and other environmental factors we are exposed to. It is about whether we smoke, how much we eat, and how active we are. It is about the food we provide to our school children and whether we have them become physically active. It's about the food that is available in neighborhoods and whether we advertise cigarettes to our children.

What's really important for our health is the fundamental health policies we have and what they foster. The big issue is, we really haven't invested enough in keeping people healthy in the first place.

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