The central policy challenge for reform of the US health care system
in the next decade will be helping society come to grips with the unsolved
problem of meeting patient needs fairly under reasonable resource constraints.
Providing an excellent level of care to all within acceptable levels of expenditure
will require a new way of thinking about quality1
and a much more open forum for public reflection and debate.2
Unfortunately, with the notable exception of the state of Oregon, US political
dialogue to date has been characterized more by avoidance and wish fulfillment
than by realistic analysis and openly acknowledged hard choices. As a nation
we are in the very early stages of a learning curve regarding setting limits
and talking candidly about rationing.
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