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Socialized medicine is not an ubiquitous reality As a result, the ability to pay often overshadows those who need medical attention the most Indeed, there is a pressing need to prioritize research in line with health needs rather than ability to pay, and the affordability of medical technologies to low-income populations and developing countries 66 As we ve seen, the limited economic opportunities in countries af icted by poverty and poor health also cause immigration A freer ow of people means greater exposure to, and faster transmission of, diseases, but also a greater possibility for developed countries with medical expertise to help countries in need more quickly than ever before For example, consider the case of Zimbabwe and the HIV/AIDS epidemic Food shortages, impoverishment, forced removals, and drought have compelled many hundreds of thousands of Zimbabweans to migrate in search of livelihood opportunities67 Despite the fact that Zimbabwe is virtually the only country in sub-Saharan Africa to stabilize and decrease its HIV/AIDS rate, it is still one of the highest in the world, at about 20 percent of its population As migrants leave for other countries, the likelihood of the disease spreading across borders increases And in countries where livelihoods can be had, the process of development itself is creating health challenges Modern industrial processes continue to cause pollution, which has a high correlation with increased incidences of asthma, lung cancer, and other respiratory and cardiovascular diseases68 A large portion of today s health problems are the result of human activities Urban development with poor regulations can result in a combination of poor infrastructure and sanitation locally but also affect the global community Big polluters, such as China and the United States, are having such a large effect on the environment that their pollution can pose a health hazard to citizens of neighboring countries, as well
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If our world is going to be able to address health in the future, it becomes necessary to rework our health care system, as well as de ne
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new global leadership roles for the WHO, the World Bank, NGOs, MNCs, and national governments We recognize xing the health care system is not a simple process Consider the 1,000-plus page act proffered the 1993 Task Force on National Health Care Reform, headed by then-First Lady Hillary Rodham Clinton The report was mocked for being protracted even by congressional standards, but frankly it would have been dif cult to navigate the United States current system of HMOs, Medicare, private insurance, and health savings accounts in fewer pages But even a quick overview can shed some light as to the general direction policy needs to move As a PricewaterhouseCoopers report notes, globally, health care is threatened by a con uence of powerful trends increasing demand, rising costs, uneven quality, misaligned incentives If ignored, they will overwhelm health systems, creating massive nancial burdens for individual countries and devastating health problems for the individuals who live in them 69 In terms of health care reform, patients, insurers, hospitals, and physicians must collaborate to provide better preventative care and education One critical reform is in the area of medical education and licensing More grants to increase the supply of doctors and nurses, as well as the creation of more exible roles so that nurse practitioners and physician s assistants can take on some of the roles currently reserved for doctors, can help to relieve the supply constraint While the United States system may be the most expensive, other countries have problems as well Countries such as Brazil, China, Russia, and India currently lose more than 20 million productive lifeyears annually to chronic disease, much of which is avoidable70 In 2002, the cumulative health spending of 24 OECD countries was $27 trillion; PricewaterhouseCoopers estimates that health spending for OECD countries will more than triple to $10 trillion by 2020 And completely socializing medicine (or making it tax-funded) is probably not the best solution More than 75 percent of hospital administrators and other medical sector executives in 27 different countries surveyed believe that nancial responsibility should be shared between taxpayers and patients Even in systems where health care is largely socialized, such as in Europe and Canada, only 20 percent of respondents favored socialized care, while the vast majority preferred a system of taxpayer funding and cost sharing by patients71
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