Some Steps Needed to Ensure the Health of America’s Children: Lessons Learned From 50 Years in Pediatrics

  • Robert J. Haggerty
    Address correspondence to Robert J. Haggerty, MD, University of Rochester, School of Medicine & Dentistry, Department of Pediatrics, Box 777, University of Rochester Medical Center, Rm 4-8104, 601 Elmwood Ave, Rochester, NY 14642
    School of Medicine & Dentistry, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
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      In 1975, while I was at the Stanford Center for Advanced Study of the Behavioral Sciences, three of us wrote a paper (never published) titled “After National Health Insurance, What?” Our opening sentence read, “Now that some form of National Health Insurance seems imminent, there will be a number of problems that providing universal health insurance to ensure access to health care will not solve.” Having established my failure as a prognosticator of the imminence of national health insurance, you may wonder why I should have any more credibility in outlining some other steps I think are needed to improve the health of America’s children, beyond access to quality health care. In spite of some gains in access to care for children, the result of expanded Medicaid and the State Children’s Health Insurance Program, 30 years later, we are not much closer to achieving universal access to health care for all children. Therefore, it seems to me even more important to implement changes in health services and deal with the other factors that will improve the health of children with, or without, universal access. It would certainly help if we had universal access, but at best that will be a floor upon which we will need to build a better house to improve the health of America’s children. In the unpublished paper noted above, we listed some of the other problems that need to be solved: lack of humane care, overuse of some costly technology with little benefit or even harm, and lack of delivery of services of proven efficacy while curtailing use of services now being given that have been proven to be of little or no value. These points are still valid.
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