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Opinion: We need a national conversation about health — not just about health care

Large-scale programs like the New Deal, enacted under President Franklin Roosevelt, addressed the foundational issues of equity and justice that underlie the structures that shape health.

Last year, Americans borrowed approximately $88 billion to pay for health care. One in four of us skipped medical appointments because of concern about costs. Such statistics reflect a trend that has been going on for decades. In 1970, the U.S. spent $74.6 billion on health. By 2000, this figure had risen to around $1.4 trillion and by 2017 it was $3.5 trillion. Not incidentally, medical debt is now the number one cause of personal bankruptcy in the U.S.

This question — Are we paying too much for health? — has defined much of the health conversation in the U.S. over the years. Unfortunately, it is the wrong question. Here’s the right one: Is our spending making us healthier?

The answer, sadly, is no.

Compared to on a range of , from adverse birth outcomes to heart disease and sexually transmitted infections. At the same time, epidemics like opioids, gun violence, and obesity are further undermining health, contributing to . All of this has occurred as we have doubled down on our investment in doctors, medicines, and cutting-edge treatments.

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