To the Editor.—Despite the reluctance
of the United States to consider universal, national health insurance, as
Dr Ginzberg1 points out, in response to
the increasing costs of health care, people may be forced to seek governmental
intervention in the form of a federal-state health program.
Although there is widespread fear of a government takeover of the health
care system, Medicare and Medicaid, which represent national health insurance
for more than 70 million Americans,2 are
reasonably effective. Without exorbitant profits, without penalizing patients
for preexisting conditions, and without using financial incentives to control
physician behavior, these programs provide care for more than 25% of the poorest,
oldest, and sickest members of the society. Concentrating on taking care of
the most needy patients and not on profits for shareholders is more in line
with a sense of equality. Unlike other items, such as vacations, new cars,
or new homes, basic health care is something to which most people feel entitled
regardless of their ability to pay. It is impossible to have such a system
if the primary goal is to generate profits, which has been demonstrated by
a managed care system.