I’ve grown wary by the run of inane commentaries by Ph.D.’s taking over the NEJM, but this one is actually not bad.

We’ve been talking about how the American health care system is on the brink of “collapse” for the last 40 years. What’s holding it together? Lawrence Brown says it’s the oft-ignored network of safety nets:

The problem with this analysis is that the U.S. health care system consists not of two sectors (private and public) but three, one of which, the safety net, rarely gets proper attention and is poorly understood. The safety net encompasses public and voluntary hospitals, community health centers, public health clinics, free clinics, and services donated by private physicians. Configurations of safety-net providers vary markedly among communities, as does their financing, a shifting patchwork of funds from Medicaid, the State Children’s Health Insurance Program (SCHIP), the federal disproportionate share program, tax levies, foundation grants, state appropriations, commercial payers, and other sources. These institutions often live on the financial edge, but with 11th-hour infusions, they mostly manage to stay afloat. This fact is of paramount importance, for these providers also extend a safety net for the political legitimacy of the health care system as a whole. That Americans who lack coverage can “still get care,” as President Bush recently declared, drains moral urgency from the health care reform enterprise.