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Calling the current health care system a "scandal" and an "abomination" and stressing the need for an increase in primary care availability, two Brown professors of medicine presented reform options to a crowded Salomon 001 in a town hall-style meeting organized Thursday, a day after President Obama's address to Congress on the subject. 

Richard Besdine, professor of medicine and director of the Center for Gerontology and Healthcare Research at Brown, and Jeffrey Borkan, professor of family medicine and chair of the department at the Alpert Medical School, addressed a crowd of mostly students at the event organized by the Janus Fellows and the Division of Campus Life.

Besdine, who formerly worked as a high-level administrator in the federal Health Care Financing Administration, said the United States recently ranked second-to-last among 30 countries in terms of healthy life expectancies, a statistic that considers the years, on average, that people spend with disabilities as well as traditional life expectancies. The country ranked last in avoiding preventable deaths caused by chronic diseases such as strokes, heart attacks and various cancers, he said.

"I don't call what we have in America a system, I call it an apparatus," Besdine said, adding that there was no "intelligent design" behind American health care.

Borkan, also a medical anthropologist, outlined various problems plaguing the current healthcare system, noting that too many specialists are flooding the field in place of primary care providers. The focus, he said, should be on preventative tests that would lower the need for more expensive emergency care in the long run.

Borkan said universities must provide incentives, such as differing tuitions depending on medical students' chosen fields, to encourage new doctors to pursue primary care, a less lucrative career path.

Besdine and Borkan also said primary care providers could prevent and combat chronic diseases by developing greater trust with their patients.

Audience members asked the speakers a variety of questions pertaining to Obama's healthcare plan, coverage of illegal noncitizens and the struggles of young people without jobs and health insurance.

Asked what they saw as the most legitimate criticism of Obama's health care plan, Borkan answered that government-run systems could not be a universal remedy for the country's ailing health care program. Nations with socialized medicine, he said, tend to pay their doctors less, discouraging citizens from entering the field.

Referring to Obama's comment that his healthcare plan would not extend to those without legal documentation, one student asked if a moral obligation existed to aiding noncitizens who are present in the United States illegally.

"Concur," Besdine simply said, while Borkan said Obama's motivation behind the statement was "politics."

A recent Brown graduate in the audience said many of his peers lacked health insurance after leaving school and failing to find jobs, adding that recent college graduates have been left out of the debate. Besdine said nearly one-third of the American population is without health insurance on any given day.

Borkan urged audience members to vote on healthcare issues when the opportunity arises.

"You've got to decide if it's a right or a privilege," he said.


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