The American Health Care Paradox: Why Spending More is Getting Us Less

to balance “upstream” work to keep people healthy through adequate services in the social sphere, with “downstream” work of medical care for people after they have become ill.

World Health Organization’s definition of health as “a state of complete physical, mental and social well-being,”

Practically speaking, this outlook manifests in the substantial attention these countries pay to buttressing services pertaining to housing, the physical environment, conditions at work, supportive social environments, family allowances, income support, unemployment support, and other social services, rather than more medications, hospital days, an

The limits placed on the practical scope of the ACOs’ mandate echoes the narratives of neighborhood health centers and HMOs, both of which started with a broader view of health and devolved to focus on medical care over time.

To some, the failure to sustain neighborhood health centers according to their original formulation is surprising, given the conceptual strength of the model, but in retrospect, this evolution might have been predicted. Like the broader policies and programs that made up the War on Poverty, the idea of neighborhood health centers was initiated from

Ironically, Truman’s well-intended initiative to increase access to health care ultimately served to escalate costs by making hospitals the centerpiece of the health care landscape.

DECISIONS ABOUT HOW TO DELIVER social and health services in Scandinavia are governed largely by the concept of local accountability. The strength of local government is apparent in comparative data from Scandinavia, France, Italy, and Great Britain, which show local government budgets accounting for larger percentages of total government spending

“The historic American practice of relying on voluntary organizations was transformed from pragmatic necessity into a high moral principle, and ultimately political ideology.”58 This ideology would later fuel a uniquely American perception of the nonprofit sector as an alternative, rather than a supplement, to state activities.

This sum of spending is what might be called the national investment in health.