Although the nation has been consumed by the issue of health system reform for the last 2 years, the focus has been relatively limited, concentrating on policies at the federal level and on the problems of accessibility and financing of insurance for personal medical services. But reform of the US health system is a considerably broader issue. Despite congressional inaction this year, profound changes are taking place through state legislative reform, the regulatory process (such as Medicaid waivers), and marketplace forces. And some policymakers in the federal government and the states are approaching health system reform not only from the vantage point of access and cost containment, but with the added goals of protecting and improving the population's health.
See also pp 1276 and 1292.
Two articles in this issue of The Journal, by Baker et al1 and by Fielding and Halfon,2 make a strong case for taking