Response to “Why Only Fixing U.S. Healthcare Will Not Make Us Healthier”

2018.03.07 Behrouz Zand MD

Behrouz Zand MD, MS blogs at Digital Antidote – The Collision of Medicine, Philosophy and Social Science. His post of January 16, 2018, is entitled “Why only fixing U.S. healthcare will not make us healthier.” Here is my response March 4, 2018:

Dr. Zand: I echo the praise for your excellent essay. In support, I invite you and your blog Followers to my WordPress blog,, for a similar approach, with more details and references. also looks at a strategic solution to the problem you posed. You formulate the problem as having 2 components: cost (affordability) and benefit (outcomes). You point out that the US scores poorly on both.

My blog looks back to Oregon in 1994. Oregon tackled both aspects of the cost-benefit problem by utilizing the emerging research technique of cost-benefit analysis to rate various healthcare services. Oregon Medicaid eliminated the least costworthy services from coverage, and thereby was able to maintain enrollment of all Medicaid-eligible citizens within a tight budget. argues that this same concept of critically rating our health system’s costs and benefits would provide the conceptual – and a politically acceptable — basis for tackling both arms of the problem as you formulate it. I think that maintaining focus on both costs and benefits would inevitably expand our attention to all the determinants of health that your post describes, including lifestyle and social factors. And it would make us more cost-conscious over the deployment of resources to target individual health and public health.

I would be interested in your reactions to

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