{"id":150,"date":"2007-03-19T12:48:43","date_gmt":"2007-03-19T11:48:43","guid":{"rendered":"http:\/\/resource.bmj.com\/bmj\/2007\/03\/19\/jama-14-mar-2007-vol-297\/"},"modified":"2007-03-19T12:48:43","modified_gmt":"2007-03-19T11:48:43","slug":"jama-14-mar-2007-vol-297","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2007\/03\/19\/jama-14-mar-2007-vol-297\/","title":{"rendered":"JAMA  14 Mar 2007  Vol 297"},"content":{"rendered":"<p>The American health care system is a mess. <!--more-->That is the theme of this week\u2019s JAMA, though in fact the sentence is pinched from the beginning of a paper in its sister journal, <a href=\"http:\/\/archinte.ama-assn.org\/cgi\/content\/extract\/167\/5\/433\">Arch Intern Med<\/a> (p.433). That paper is well worth reading as a defence of the idea of tiered health care \u2013 though I remain appalled.<\/p>\n<p>Here the first paper in JAMA (p.1063) shows that the current pattern of tiered health care in the USA ensures worse <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/abstract\/297\/10\/1063\">outcomes following myocardial infarction<\/a> according to the ability to pay for drugs and services.<\/p>\n<p>For <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/abstract\/297\/10\/1073\">chronic conditions<\/a> too, outcomes vary according to the level of insurance (p.1073).<\/p>\n<p>Whole sections of society \u2013 above all <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/abstract\/297\/10\/1085\">undocumented immigrants<\/a> \u2013 have no official medical cover but do receive Emergency Medicaid (p.1085)<\/p>\n<p>The answer must come from better <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/abstract\/297\/10\/1103\">physician leadership<\/a>, according to an interesting and idealistic article by two non-physicians (p.1103).<\/p>\n<p>Ah, if only. The present state of our own dear NHS offers the worst possible example. Physicians here are denigrated as self-interested, regarded as mere expensive pairs of hands, and disempowered by the ideology of the market (see Iona Heath\u2019s Lancet editorial, p.866).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The American health care system is a mess. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmj\/2007\/03\/19\/jama-14-mar-2007-vol-297\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38363,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[111],"tags":[],"class_list":["post-150","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-lehmans-weekly-review-of-medical-journals"],"jetpack_featured_media_url":"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/150","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=150"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/150\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/38363"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=150"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=150"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=150"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}