Perfect health-care delivery would have little effect

Former commissioner of health says America must do more to improve health

By Jeff Hansel

Mark July on the calendar as a time to discuss health care.

Olmsted Medical Center this week played host to the first Noel R. Peterson Founders Lecture.


The annual series is the result of an endowment from Dr. Peterson and his wife. Lectures will feature contemporary topics from the field of medicine.

The inaugural event focused on health-care reform and featured a presentation by former Minnesota Commissioner of Health Jan Malcolm titled "Spending More and Getting Less: How Can the U.S. Improve Health and Health Care for All?"

Malcolm told an audience of about 80 people that the United States:

Spends 50 percent more per capita than any other country on health care, but ranks 37th overall in World Health Organization rankings.

Ranks about 25th in life expectancy.

Has seen its infant mortality ranking fall in recent decades.

If health-care delivery became perfect, she said, it would have only a small effect on improving national health. Instead, she proposed, there must be an investment in changing behaviors, improving socio-economic status, performing genetic analysis and improving physical environments. That, she said, could have a tremendous effect on the general health of U.S. citizens, noting that it's hard for some people to accept the small part health care might play in improving health for U.S. citizens.

But, Malcolm pointed out, "ability to access health care doesn't override all the other stuff."


The law requires that all patients visiting a U.S. emergency room be seen. So all Americans have access to emergency health care, Malcolm said. But that doesn't mean everyone can afford regular checkups, a good diet, necessary medication or fitness-center memberships.

Malcolm made specific suggestions for improving the health of U.S. citizens:

Invest in preventive care. That means making sure people get the right kind of care at the right time.

Consider public health a priority. Things like safe drinking water and sanitary sewer systems improved the population's health. Focusing on prevention of illness, and providing excellent treatment of chronic conditions will lower cost in the long run and have similar effects.

Discuss the priorities of what must be covered by insurance and government programs. That requires considering both scientific evidence and values.

Offer financial rewards to medical systems that produce good patient outcomes.

It's not a quick fix, Malcolm said.

"The potential to do better is fairly clear. But it takes a longer-term perspective," she said.


After Malcolm's lecture, Noel Peterson mulled her concepts. He said it should be harder to be wealthy -- and harder to be poor -- in the United States.

"How can you talk about good exercise, eating right, when you have to work three jobs?" he asked.

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