Seeking a national solution to health care for all

Medicine is witnessing the best and worst of times because of the “staggering difference” between lifesaving advances and the “very broken” economics of health care delivery, said James J. Mongan, M.D., president and CEO of Boston-based Partners Health-Care System, during a talk at the medical school in September.

Mongan, who delivered the 11th annual Samuel O. Thier Lecture in Health Policy, said that the landscape of health care finance has shifted from one dominated by government programs to a regulatory/free-market hybrid that includes Medicare, Medicaid and managed care. Attempts to broaden coverage through employer mandates have failed because of a “tenacious desire for autonomy” in the private sector—businesses have exploited “our national ambivalence about heavy-handed government regulations” and taxation.

Meanwhile, 45 million uninsured Americans get emergency room treatment when they are sick instead of preventive care. Ignoring the cost of this tendency is dangerous, Mongan warned. While Massachusetts has a “promising” if flawed system to insure its residents, providing health care for all citizens “will demand some national action,” Mongan said, though he wasn’t optimistic that such action could be taken in the heat of a presidential campaign. “We currently stand as a nation without a good answer.”