A new post to my Curing Healthcare blog answers the qustion: Who is worthy of having adequate health insurance and high-value (safe,
cost-effective) care and what makes them deserving; and who is unworthy?

I start by examining health insurance and how the American Capitalist model
currently considers three groups as worthy of having at least minimally
sufficient healthcare coverage: Those with adequate financial resources
(employees with employer-based insurance and the wealthy); older adults
(receiving Medicare, at least until the program defaults); and the poor (who
receive Medicaid). But even with these “worthy” groups, only those with the
financial means have regular access to high-priced healthcare providers (such
as “boutique clinics” and expensive specialists who refuse Medicare and
Medicaid) versus overworked and underpaid primary care physicians and
community/public health centers. And some argue that these groups should be
further restricted to only those people who take good care of themselves (e.g.,
drug addicts, smokers, alcoholics, over-eaters, etc.) are undeserving and
should lose their coverage.

It then argue that our failure to deliver high-value wellcare and sickcare
consistently to anyone, no matter how wealthy one is and how much insurance
coverage one has, is the great equalizer. Safe, effective, appropriate and
timely care—delivered efficiently and affordably—is rare in America. Problems with poor
care quality and waste are endemic, and our nation has been doing little to
gain and use the scientific knowledge and information tools needed change
things around.

My conclusion is that the only way to improve
healthcare quality and control costs—and sustain these benefits well into the
future—is for our highest priority to focus on obtaining and using clinical
knowledge wisely by rewarding the use of evolving evidence-based knowledge to
support decisions about how best to prevent health problems and treat them
cost-effectively. Such solutions would overcome devastating effect of today’s
limited healthcare knowledge and broken economic models.

I make the case that we ought to consider all Americans and other legal
residents as being worthy of adequate health insurance coverage. being
worthy of high-value (safe, effective and efficient) care. This means
transforming our current healthcare system into one that focuses on eliminating
waste, errors, over-treatment, under-treatment, inappropriate treatment,
ineffective interventions, dangerous medications, etc. It also means doing a
better job with prevention and other aspects of well-care.

I conclude our country could afford to deliver high-value care to all our
citizens and others (including undocumented workers and their families) if we
replaced waste & inefficiency, ineffectiveness, greed, ignorance, secrecy
and misaligned incentives, which benefit an “economically worthy” few … with … efficient,
safe & effective, economical, scientific knowledge-based, transparent, and
appropriately incentivized wellcare and sickcare for all.