Despite the fact that the United States spends more on medicine than any other nation, the country is facing a health care crisis as its health care system is in danger of collapse.

The current health care system is increasingly failing patients and medical staff, and its flaws could become evident in the event of a biological attach, according to neuroscientist-physician Dr. Floyd Bloom, president of the American Association for the Advancement of Science (AAAS).

The American health care system needs to be redrawn, according to Bloom, and there are four major reasons why:

• Costs of medications are exceeding the ability of employers to pay for them
• Patients are not satisfied with their care
• High rates of malpractice insurance are demoralizing physicians about the practice of medicine
• It is becoming increasingly difficult to recruit nurses

Other reasons mentioned include rising health insurance premiums, shortages of expertise in a number of specialties and outdated methods of information management.

Another major flaw in the system is its reliance on hi-tech surgical procedures and drugs. The system is "reactive" in that it waits until someone is sick and then looks for a way to solve the problem. Preventive medicine, rather than drugs and surgeries, should be the foundation for the system.

Communication is also a problem. For example, there are more than 10,000 drugs available for treating the increasingly elderly population. Many of these drugs can cause interactions, but patients typically see several doctors who do not know what drugs the others are prescribing.

One overriding theme is that simple measures should be taken first, rather than waiting for hi-tech discoveries to change the system. Human genome research is an over-anticipated breakthrough that is not likely to provide any dramatic results for years, according to Bloom. There are simpler things that can, and should, be done right away that can produce significant benefits.

British Medical Journal February 22, 2003;326:416