Issue 14. April 2018

design & healthcare

Given that the US healthcare system is by many accounts a failure, what will it take to fix it? As the great healthcare debate endlessly rages on throughout the country, let’s take some time to consider what counts as success in this arena.

Is it, as is most often talked about, maximizing the percentage of people that are covered by health insurance? If so, is it safe to assume that the ability to pay for healthcare translates to access to healthcare services? And, would greater access to our current healthcare infrastructure necessarily translate to a healthier populace?

All of us have had interactions with medical professionals and understand what it is like to sit under fluorescent lights waiting for news, good or bad. Because such interactions are routine, their constructed nature is often taken for granted, and the fundamental humanness of such encounters is unrecognized.

Rachel Heidenry on Standardized Patient (below), Art12 Magazine, 2017


Effective policies can ensure that states and Union territories’ incremental spending goes to health, but also enhances value for money. This is because funding can be linked to cost-effective interventions, such as preventive and primary care activities, rather than less cost-effective (but more visible, and therefore more politically attractive) interventions, such as construction of new hospitals.

The Importance of Investing in Health, The World Economic Forum, 2015

I think there are underappreciated but accepted American values that people should not be left to suffer, that people should not be placed at a disadvantage through no fault of their own, and that, as a community of caring people, we should be outraged when the basic necessities aren't guaranteed. I think over the last 20 or 30 years, maybe even the last 40 years, there has been both an erosion of the recognition of those important values and also a substitution with another set of values — values that are much more harsh and economically driven and that do not presume that the people, or the public, should not be placed in positions of vulnerability.

Christina Breitbeil, Rethinking the Social Contract, Real Clear Policy, 2014

The dirty truth about American health care is that it costs more not because insurers are so powerful, but because they’re so weak.

Ezra Klein, What Liberals Get Wrong About Single Payer, 2014

When it came to a [cancer] survivor’s likelihood of seeking follow-up care, investigators found no significant difference based on cancer type or health insurance status.

Younger Cancer Survivors Found to Skip Out on Follow-Up Care, Cure, 2018

system goals

The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.

The Physician Charter, ABIM Foundation, 2002

Social services focus on the basic necessities of life, helping ensure that individuals receive adequate nutrition, proper shelter, and a subsistence income, all of which are essential to maintaining good health. When such fundamental needs are unmet, disease and illness often follow, and even after care is administered patients are highly vulnerable to relapse. Nearly one in five Medicare patients discharged from a hospital is readmitted within 30 days, resulting in an annual cost of more than $26 billion.

Kenneth Davis, Health Affairs, 2015

systemic failure

It's a stunning example of how poorly the American health care system stacks up against its developed peers. More women in labor or brand new mothers die here than in any other high-income country. And the CDC Foundation estimates that 60 percent of these deaths are preventable.

Julia Belluz, California decided it was tired of women bleeding to death in childbirth, 2017

This morning, we had a lady with post-menopausal bleeding, which could be cancer. The absolute best thing to do is have her checked out by a gynecologist, but we really don’t have a way to do that that she can afford. The health department has some programs, but they generally require a diagnosis of cancer before their programs can pick up.

Dr. Karen Kinsell, A Doctor’s View of Obamacare and Trumpcare from Rural Georgia, 2017

Over the last few years, Medicaid and health care have become increasingly politicized. But physicians must remember that behind all the double-speak, pretense, and charades are real people like Gerald who need care. Refusing to see them is nothing less than discrimination by another name.

Sumit Agarwal, STAT, 2017

There was a continuing disparity in the burden of death and illness experienced by Blacks and other minority Americans as compared with our nation’s population as a whole. That disparity has existed ever since accurate federal record keeping began… an affront both to our ideals and to the ongoing genius of American Medicine.

Margaret Heckler et al., Report of the Secretary's Task Force on Black and Minority Health, 1985

Medical students looking to score high on their board exams sometimes get a bit of uncomfortable advice: Embrace racial stereotypes.

Ike Swetlitz, STAT, 2016

"I am an employed, white, educated woman with no kids, with access to transportation and the internet. I don't have a criminal history, no history of drug use, and I've never been a sex worker," Leah says. "I feel incredible pressure to use my privilege to get something done because if I couldn't do it, nobody can do it. It has to change."

New bill aims to help rape victims rebuffed at hospitals, CNN, 2016


The rapidly growing initiative, which has gotten little publicity outside the country, offers virtually open-ended talk therapy free of charge at clinics throughout the country: in remote farming villages, industrial suburbs, isolated immigrant communities and high-end enclaves. The goal is to eventually create a system of primary care for mental health not just for England but for all of Britain.

England’s Mental Health Experiment: No-Cost Talk Therapy, 2017

Tejeda’s visit is an example of an approach that’s beginning to catch on in modern American health care, that of pushing care outward from expensive hospital settings and into people’s homes, keeping diseases in check and preventing patients from cycling in and out of the emergency room.

Joanne Kenen, New York borrows a health care idea from Africa, Politico, 2017