Overview
It is time to rethink where we are trying to go with health care in America, and how we might begin to get there. Most agree that changes are needed, but efforts to reform health care as a whole have washed ashore, drowning in the whirlpools and eddies of special interest politics. This is all-too-familiar: from 191.7 to the present, most political efforts to reform health care in the United States at a basic level have suffered similar fates. The plight of our most recent political expedition into these waters can be instructive, but only if understood as part of a larger saga. Meanwhile, over the past half-century, public and private efforts to introduce more limited reforms have often succeeded. They have changed the fundamental character of health care, but have not tamed its cost dynamic. Some of these more limited reforms have made the problems which remain more intense.
American health care has become dramatically different from that which developed elsewhere in the world. Its character has changed during the past 60 years, as health - care providers, business leaders, politicians, and various segments of the American public responded to new circumstances. Wars, evolving economic relations, population changes, and a variety of demands and pressures from social and political movements affected the organization of health - care services in the U.S. The end result has been ironic: on the one hand, American medicine has become the pace-setter for the rest of the world in terms of medical research and high-tech delivery of sophisticated medical services. Yet when the actual health status of the population is measured, the United States continues to fall short of what is being achieved in several other advanced industrial societies. There is a growing consensus that American health care is in crisis, and that.......
