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Too Little, Too Late: The Limits of Clinical Medicine in Improving National Health 2021

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The U.S. spends 18 % of its GDP on health care, most of this aimed at clinical treatment of individual patients.  The impact of COVID-19 has exposed the limits of our massive spending in achieving health for vulnerable populations in the United States.  I will expose some of the limits of health care spending, using a Health Impact Pyramid that compares resources spent to their impact -- across a society: improvements in socioeconomic factors; public health interventions such as clean water; tools such as immunizations with long term benefits; direct clinical care, and finally counseling and education.  Public actions and interventions represented by the base of the pyramid require less individual effort and have the greatest population health impact.  I will trace the development of the U.S. system, some of the often ignored goals of Obama‚Äôs Affordable Care Act, and the increasing contortions of our current health care system -- to show where our payment system falls short as the result of systemic constraints we have built into our health care system.  And I will suggest some new directions for improving American health by reallocating health care dollars. 
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Prof. Barry R. Furrow Drexel University Kline School of Law
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