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How to Fix a Broken Health Care System

3) Our stubborn insistence that health care is a product for sale if you can afford it rather than a basic human need.

Charles E. Bouchard
St. Louis
The writer is senior director, theology and ethics, at the Catholic Health Association.

To the Editor:

When I began my new job in 1975 as the financial manager at a primary care clinic, I was shocked at how few primary care doctors were in the community and how little money went to primary care and prevention services. As I prepare to retire, I am saddened, but not shocked, at the state of the American sick care (not health care) system.

We need to find ways, big and small, to push more money upstream to fund prevention, early intervention, primary care, affordable housing, violence prevention and so on. If done thoughtfully, we can begin to slowly reduce the number of “customers” of the sick care system — reduced emergency room visits, hospital admissions, diagnostic imaging procedures and specialist visits. This would free up a surprising amount of money that could be moved upstream, creating a virtuous upward cycle that will result in a true “health care system.”

It’s happening right now, supported by young people and enlightened employers who are refusing to play in the old game. I’m excited and optimistic.

Dale Jarvis
Seattle

To the Editor:

The six-year period that I spent without health insurance — long before the Affordable Care Act became law — was a frightening experience. Even after I acquired insurance upon re-entering the work force, I spent so much money on monthly payments, co-pays and deductibles that I could barely afford basic necessities.

The current law is a hodgepodge that must be grounded in a stronger, more reliable system. A program is needed to guarantee that all citizens with limited income are insured while those who are better off pay for part or all of their insurance.