National Health Policy: What Role for Government?

Much of the material included in this conference volume differs from what is typically found in similar publications dealing with health policy issues in that it exhibits willingness to re-examine and question the all-too-frequent assertion by many specialists that the transformation of the American health system from a private to a public enterprise is inevitable. It is commonly argued that the American health care system is imperfect: health levels of the population are not the highest in the world; access to health care services is incomplete, especially for the poor and the chronically ill; there are no complete health insurance plans against all medical and related contingencies; and some segments of the population lack any insurance coverage. Moreover, there is medical cost inflation; and despite an apparent unchecked trend to commit a growing share of the national pie to health care services, the system stills fails to eliminate various inequities in the distribution of services across different areas or population groups. Thus everyone knows, goes the argument, that it is the government which must intervene and shoulder a major responsibility for alleviating these problems. Indeed, if one looks at the developments in some other Western countries in recent decades, the inevitable solutions seems to be in the direction of establishing at the very least a national health insurance plan, if not a national health system modeled after the British or Canadian examples. Yet many papers included in this volume express skepticism regarding both the diagnosis of the American health system as fundamentally ailing and the prescription of greater public intervention in the financing and delivery of medical services as the remedy and sure path to recovery.