The health of nations.

• Position: Health economist Douglas Bradham - Interview

Health economist Douglas Bradham holds a joint position as an associate professor at Bowman Gray School of Medicine's Department of Public Health Sciences and Wake Forest University's Babcock Graduate School of Management. A Goldsboro native, he earned all of his degrees at UNC Chapel Hill: bachelor's in chemistry and economics, master's in health administration and health economics and a Ph.D. from the School of Public Health. He managed a nonprofit health-care planning agency in Grand Forks, N.D., and taught at the University of Florida and the University of South Florida before coming to Winston-Salem in 1992.

BNC: How would you rate North Carolina's health-care system?

Other parts of the country have a much longer history of managed care than North Carolina. In Florida, where I used to work, hundreds of small businesses were coalescing into cooperatives, which then became major purchasers of health care. That led to the savings of substantial dollars. That kind of activity has not been evident in North Carolina, but the reform movement is pushing that transition very rapidly.

On the other hand, North Carolina on the state level has encouraged health-care reform. The state has positioned itself quite well to be ready to implement reforms. But there is a lot of evidence that Congress can take a long time to make these decisions. It would be foolish to wait. I think we're looking at a two-year period of legislative negotiation and 10 to 15 years of fine-tuning of the new structure.

BNC: But won't the Clinton health plan sock it to the business community?

It seems to me that the Clinton plan represents an opportunity to restructure the health system so that an equitable financing mechanism can be achieved. Equity in this case means everyone paying their fair share so that everyone can be given access to necessary care. That suggests that health care for necessary items is a right.

One of the reasons that we are in the position in which almost 14% of our economic productivity is spent on health care is because we are such voracious consumers of health care. That is in part because the health-care industry mainly provides procedures but not advice on how we can prevent disease. Much of the behavior of the American public is dangerous for its health. Thus if the health-care system provides no incentive to hold us responsible for our actions, we are sure to take the path of least resistance. But one of the incredibly important things in...