Think Nationally, Act Locally

  • Lane P. Johnson


Our favorite description of the United State Health Care system was one given by Dr. Terry Cullen in a lecture to a class of medical students in a Masters of Public Health (MPH) Program. Dr. Cullen described the US Health Care system as a patchwork quilt with a lot of big holes in it (Cullen 2008).

Approaching the question of what can be done to provide quality, lower cost, and accessible health care to the entire US population, the patchwork quilt is an apt metaphor. There are pieces of the quilt that are of excellent quality, pieces that do the job more than adequately, other pieces that are old and falling apart, and gaping holes that leave large sections of the bed uncovered. So what can one do with an old quilt? Commit to re-covering the entire structure? Patch the holes as best as one can? Throw it away and start again? Such is the dilemma that confronts the remodeling of the American Health Care System. What is not lacking is a wide spectrum of strong opinions about how it should be done.

It is not likely that the health care system will be made anew. An essay by Atul Gawande in the New Yorker (2009) does a wonderful job in outlining how most countries, when they have implemented national health care systems, have designed the system based upon the history, politics, policies, and institutions that were already in existence in that country. This is one reason why there is such a diversity of national health systems in countries across the world: government-run, employer-funded, private insurance based, separate national taxes for health care, etc.; each country’s system reflects the political environment of that country at the time of the implementation of their national health care system.


State Legislature National Health Insurance Program National Health Care System American Health Care System Patchwork Quilt 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Burton A, Friedenzohn I, Martinez-Vidal E (2007) State strategies to expand health insurance coverage: trends and lessons for policymakers, in State of the States 2007; Building hope, raising expectations, Robert Wood Johnson Foundation’s State Coverage Initiatives Program. Available at Accessed 10 May 2008
  2. Belluck P (2007) As health plan falters, main explores changes. New York Times. April 30, 2007. Available at Accessed 10 May 2008
  3. Cullen T (2008) Class lecture on indigent Care, Issues and Trends in Public Health, MD-MPH Dual Degree Program, Tucson, AZ, OctoberGoogle Scholar
  4. D’Angelo G, Moffit RE (2006) Building on the successes of health savings accounts. The Heritage Foundation, October 20. Available at Accessed 5 Apr 2009
  5. Fahrenthold D (2006) Mass. Bill requires health coverage, Washington Post, April 5, 2006. Available at Accessed 10 May 2008
  6. Gauthier A (2006) Why not the best? A high performance health system in Hawaii. Hawaii Uninsured Project Fall Forum, October 2006. Available at wealth.10.23.06.ppt. Accessed 10 May 2008
  7. Gawande A (2009) Getting there from here. The New Yorker. January 26, 2009. Available at Accessed 5 Apr 2009
  8. (2007) United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act), (database of federal legislation) Available at Accessed 5 Apr 2009
  9. Grijalva R (2009) Healthcare Change Forum; February 14, 2009, Tucson, AZGoogle Scholar
  10. Imas K (2007) Under the microscope; states serve as laboratories for Universal Health Care Programs. State News; the council of state governments. February. Available at Accessed 10 May 2008
  11. Kaiser Commission on Medicaid and the Uninsured (2008) States moving towards comprehensive health care reform. Available at Accessed May 10, 2008
  12. Montgomery K (2006) What was the Clinton Health Plan Proposal about, and why did it fail? Health Insurance; Retrieved 5 Apr 2009 from
  13. Nardin R, Himmelstein D, Woolhandler S (2009) Massachusetts’ Plan: a failed model for health reform. Physicians for a National Health Program. February 18, 2009. Retrieved 5 Apr 2009 from
  14. National Conference of State Legislatures (2008) Comprehensive reforms; state examples, May 10, 2008, Accessed 10 May 2008
  15. Oberlander J (2007) Learning from failure in health care reform. NEJM 357(17):1677–1679CrossRefPubMedGoogle Scholar
  16. Pear R (2009) Obama offers broad plan to revamp health care. New York Times, 26 February 2009. Available at Accessed 5 Apr 2009
  17. Sack K (2007) San Francisco to offer care for uninsured adults. New York Times, September 14, 2007. Available at Accessed 11 May 2008
  18. Sack K (2008) In Massachusetts, Universal coverage strains care. New York Times, April 5, 2008. Available at 20care%22&st=cse. Accessed 5 Apr 2009
  19. Sack K (2009) Massachusetts faces costs of big health care plan. New York Times, March 15, 2009. Available at Accessed 5 Apr 2009
  20. Sidortsova S (2008) Scoring catamount health. Vermont Public Interest Research and Education Fund. August, 2008. Available at Accessed 5 April 2009
  21. Sylvester B (2009) Health Experts Debate Baldacci’s health plan. The Maine Campus, October 5, 2006. Available at Accessed 5 April, 2009
  22. The White House (2009) Health Care. Available at Accessed 5 April 2009


  1. Ascension Health, Healthcare that leaves no one behind.
  2. Cover the Uninsured, A Project of the Robert Wood Johnson Foundation.
  3. National Association of Community Health Centers, Access for All America Plan.
  4. National Conference of State Legislatures, Access to Healthcare and the Uninsured.
  5. St Luke’s Health Initiative, A Catalyst for Community Health.
  6. The Commonwealth Fund, Health Insurance. 309
  7. The Kaiser Family Foundation, Health Coverage and the Uninsured. america.cfm

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Arizona Health Sciences CenterTucsonUSA

Personalised recommendations