Rethinking national health insurance
Most Americans, the polls report, are alarmed by a “medical-care crisis.” Yet most are also satisfied with their own medical treatment. This paradox suggests that the admittedly serious problems of American medicine-its cost, availability, and quality-are not the only concerns. Part of the difficulty is the rhetorical exaggeration of medical-care problems and the unrealistic expectations for the proposals for national health insurance. Any sensible national-health-insurance plan must balance conflicting purposes. It must be fiscally possible, administratively manageable, politically feasible, and capable of improving the health of Americans without accelerating the worrisome rate of medical inflation (14 per cent in 1975). Yet many proponents of national health insurance misleadingly suggest that the problems of cost, access, and quality can be relieved simultaneously; few realistically show how to meet the conflicting constraints of cost control, administrative simplicity, and medical effectiveness. In what follows, I will try to chart a course between the clichés of impending doom and the smug complacency that American medicine is healthy.