Health Care Reform at the Close of the 20th Century
The New England Journal of Medicine, June 17, 1999, Vol.340, No
24
Reading this article causes one to ponder many issues and consider
possible solutions. The future of our healthcare system is certainly
an issue which will effect our well being in the next century.
Some of the problems sited are the large and growing number of
uninsured Americans, the high overall costs of our health care
system, pervasive evidence of suboptimal quality of care. Current
political debate does not address the persistent problems of access
to care and its quality and cost.
Why have recent discussions of health policy been so limited in
scope? What conditions will be required to reawaken public interest
in comprehensive health care reform? If the public is not engaged
in the nations unresolved health care problems, the elected representatives
will not have the political well to address them. The voting public,
especially low and middle income Americans, must come to the conclusion
the the current health care situations is so intolerable that
government intervention cannot make it worse.
Currently 43 million persons are uninsured. That is approximately
20% (16% among employed). It is estimated that the proportion
would have to exceed 25 to 30% to trigger changes in current policy
and political reality. What could cause this? A catastrophic event
such as the depression of the 1930s, another world war, a disease
pandemic dwarfing the AIDS epidemic, sudden collapse or the managed
care industry, return to the galloping inflation of the 1970s
and 1980s. These would all be very high prices to pay.
There is no unequivocally correct solution to this dilemma. In
the short term effort to improve the equity, efficiency, and quality
of our health care system must focus on incremental improvements
in our current system. Child health is a very good place to start.
For more information, contact Urban Health Care Action Network at www.uhcan.org or Metro NY Health Care for All metrohealth@igc.org
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