US health care system: too much focus on medical care

in oct 28 boston globe there was a review of a book "the health care paradox", by elizabeth bradley and lauren taylor, public-health specialists -- see http://www.bostonglobe.com/arts/books/2013/10/27/book-review-the-american-health-care-paradox-why-spending-more-getting-less-elizabeth-bradley-and-lauren-taylor/ynV1Sl5n0jZ1FUN817j4XN/story.html, which promotes a broader critique of the health care system.

so, i must admit that in my past emails, i have railed against the US health care system, which spends more per person than any other (around 2x as much as next closest country) and has remarkably poor health outcomes (much worse than other industrialized countries and worse than several less-industrialized ones), and that has to do with the lack of a coordinated, coherent, accessible system of care, and unfettered profit-taking by drug companies, medical supply companies, hospitals, etc. And that the fix was to develop a public-sector coherent system, similar to other countries' approximation to a one-payor system.

but the point of this book is appropriately more expansive: social issues (eg for adequate housing, affordable daycare, home-based services for disabled, food security, etc, and i might add, income inequality) are at least as important as the health care system itself as the foundation for peoples' health and well-being. if one includes social costs with the direct health care expenditures,  the US sinks to be 13th in spending (ie, we are way below most other industrialized countries in social program spending).  

so a major part of the problem extends beyond the specific deficiencies of our health care system per se as noted above and very much into the social sphere overall (it is rather telling that as the median income since 2008 has fallen 4% for the bottom 93% of the population but increased 28% for the top 7%, yet in this situation even the Democratic-controlled senate is pushing for a $4 billion cut over 10 years in food stamps -- though still better than the $40 billion cut proposed by the Republican-controlled house). and it stresses that we think about health much more broadly than just the health care system itself. perhaps the most important deficiency of the “health care system” is the seemingly relentless attack on social programs.