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August 25, 1993, Vol 270, No. 8 >
ARTICLE | August 25, 1993

The United States Needs a Health System Like Other Countries FREE

William A. Glaser, PhD
[+] Author Affiliations

Reprint requests to Health Services Management, New School for Social Research, 66 Fifth Ave, New York, NY 10011 (Dr Glaser).


JAMA. 1993;270(8):980-984. doi:10.1001/jama.1993.03510080084036
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References

Every developed country except the United States has a comprehensive health system for coverage, service provision, and finance. Social policy in the United States once was guided by thinkers who realized this, and the Social Security system—complete except for health insurance—resulted. The climate of thinking changed, and health policy for some time has been dominated by classical economists who argue that free competitive markets will solve all problems. They justify their arguments by claiming that the only alternative is full government takeovers of service and financing, as in Canada. While this debate has dragged along, problems in the United States have become grave. Instead of reviving the institutional economics and social policies that once served the United States well, the Clinton administration has turned policy over to devotees of managed competition. But the problem is how to organize the country, and national health insurance—easily observed in other countries—is superior to the current chaos and free-market utopias in the United States. Important aims would be achieved, such as expanding coverage, obtaining stable revenue, and containing costs. Important political barriers can be overcome, such as resistance by small business. Such a health system includes machinery for setting goals and implementing results, involving collaboration among providers, payers, and government.

(JAMA. 1993;270:980-984)

REFERENCES

1 +
Falk IS. Security Against Sickness . Garden City, NY: Doubleday, Doran; 1936;.
2 +
Poen MM. Harry S. Truman Versus the Medical Lobby . Columbia: University of Missouri Press; 1979;:  chap 1-4. 
3 +
Munts R. Bargaining for Health: Labor Unions, Health Insurance and Medical Care . Madison: University of Wisconsin Press; 1967;.
4 +
Greenberg W, ed. Competition in the Health Care Sector: Past, Present, and Future . Germantown, Md: Aspen Systems Corp; 1979;.
5 +
Langwell I, Moore SF. A Synthesis of Research on Competition in the Financing and Delivery of Health Services . Washington, DC: US Dept of Health and Human Services, National Center for Health Services Research; 1982;. US Dept of Health and Human Services publication PHS 83-3327.
6 +
Enthoven AC. Theory and Practice of Managed Competition in Health Care Finance . Amsterdam, the Netherlands: North-Holland; 1988;.
7 +
Enthoven AC, Kronick R.  A consumer-choice health plan for the 1990s. N Engl J Med . 1989;;320: 29-37, 94-101.
8 +
Butler SM, Haislmaier EF, eds. A National Health System for America . Washington, DC: Heritage Foundation; 1989;.
9 +
Pauly MV, Danzon P, Feldstein P, Hoff J.  A plan for 'responsible national health insurance.' Health Aff . 1991;;10:5-25.
10 +
Simmons HE, Rhoades MM, Goldberg MA.  Comprehensive health care reform and managed competition. N Engl J Med . 1992;;327:1525-1528.
11 +
Langwell KM, Staines VS, Gordon N. The Effects of Managed Care on Use and Costs of Health Services and The Potential Impact of Certain Forms of Managed Care on Health Care Expenditures . Washington, DC: Congressional Budget Office; 1992;.
12 +
Gabel JR, Rice T.  Is managed competition a field of dreams? J Am Health Policy . 1993;;3:19-24.
13 +
Socolar D, Sager A, Hiam P.  Competing to death: California's high-risk system. J Am Health Policy . 1992;;2:45-50.
14 +
Kosterlitz J.  Monopoly medicine? Natl J . 1993;; 25:1746-1749.
15 +
Himmelstein DV, Woolhandler S.  A national health program for the United States: a physicians' proposal. N Engl J Med . 1989;;320:102-108.
16 +
Priest D.  The road to health care reform. Washington Post Health . (January 26) , 1993;:12-17.
17 +
Bush GHW. The President's Comprehensive Health Reform Program . Washington, DC: White House; 1992;:69-77.
18 +
Barer ML, Evans RG.  Interpreting Canada: models, mind-sets, and myths. Health Aff . 1992;;11:44-61.
19 +
Jackson Hole Group. The 21st-Century American Health System: A Proposal for Reform . Minneapolis, Minn:InterStudy; 1992;.
20 +
Stenholm CW, Cooper J, Andrews M. Proposal of the Conservative Democratic Forum's Task Force on Health Care Reform (The Accountable Health Plans and Managed Competition Act of 1992) . Washington, DC: US House of Representatives; 1992;.
21 +
Glaser WA. Health Insurance in Practice . San Francisco, Calif: Jossey-Bass; 1991;.
22 +
Roemer MI. National Health Systems of the World . New York, NY: Oxford University Press; 1991;.
23 +
Glaser WA. Health Insurance Bargaining . New York, NY: Gardner Press; 1978;.
24 +
Glaser WA.  Lessons from Germany. J Health Polit Policy Law . 1983;;8:359-361.
25 +
McCormick B.  'Any willing provider' laws are a key reform issue. Am Med News . (June 7) , 1993;:3, 30.
26 +
Glaser WA. Paying the Hospital . San Francisco, Calif: Jossey-Bass; 1987;.
27 +
Coulam RF, Gaumer GL.  Medicare's prospective payment system: a critical appraisal. Health Care Finance Rev . 1991;;12( (suppl) ):46-53,61-63, 69-72.
28 +
Brown ER, Dallek G.  Changing health care in Los Angeles.  In: Ginzberg E, Berliner H, eds. Changing US Health Care: A Study of Four Metropolitan Areas . Boulder, Colo: Westview; 1993;.
29 +
Robinson JC, Luft HS.  Competition, regulation, and hospital costs: 1982 to 1986. JAMA . 1988;;260: 2676-2681.
30 +
Glaser WA.  How expenditure caps and expenditure targets really work. Milbank Q . 1993;;71:97-128.
31 +
Starr P, Zelman WA.  Bridge to compromise: competition under a budget. Health Aff . 1993;;12 ( (suppl) ):7-23.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Falk IS. Security Against Sickness . Garden City, NY: Doubleday, Doran; 1936;.
2 +
Poen MM. Harry S. Truman Versus the Medical Lobby . Columbia: University of Missouri Press; 1979;:  chap 1-4. 
3 +
Munts R. Bargaining for Health: Labor Unions, Health Insurance and Medical Care . Madison: University of Wisconsin Press; 1967;.
4 +
Greenberg W, ed. Competition in the Health Care Sector: Past, Present, and Future . Germantown, Md: Aspen Systems Corp; 1979;.
5 +
Langwell I, Moore SF. A Synthesis of Research on Competition in the Financing and Delivery of Health Services . Washington, DC: US Dept of Health and Human Services, National Center for Health Services Research; 1982;. US Dept of Health and Human Services publication PHS 83-3327.
6 +
Enthoven AC. Theory and Practice of Managed Competition in Health Care Finance . Amsterdam, the Netherlands: North-Holland; 1988;.
7 +
Enthoven AC, Kronick R.  A consumer-choice health plan for the 1990s. N Engl J Med . 1989;;320: 29-37, 94-101.
8 +
Butler SM, Haislmaier EF, eds. A National Health System for America . Washington, DC: Heritage Foundation; 1989;.
9 +
Pauly MV, Danzon P, Feldstein P, Hoff J.  A plan for 'responsible national health insurance.' Health Aff . 1991;;10:5-25.
10 +
Simmons HE, Rhoades MM, Goldberg MA.  Comprehensive health care reform and managed competition. N Engl J Med . 1992;;327:1525-1528.
11 +
Langwell KM, Staines VS, Gordon N. The Effects of Managed Care on Use and Costs of Health Services and The Potential Impact of Certain Forms of Managed Care on Health Care Expenditures . Washington, DC: Congressional Budget Office; 1992;.
12 +
Gabel JR, Rice T.  Is managed competition a field of dreams? J Am Health Policy . 1993;;3:19-24.
13 +
Socolar D, Sager A, Hiam P.  Competing to death: California's high-risk system. J Am Health Policy . 1992;;2:45-50.
14 +
Kosterlitz J.  Monopoly medicine? Natl J . 1993;; 25:1746-1749.
15 +
Himmelstein DV, Woolhandler S.  A national health program for the United States: a physicians' proposal. N Engl J Med . 1989;;320:102-108.
16 +
Priest D.  The road to health care reform. Washington Post Health . (January 26) , 1993;:12-17.
17 +
Bush GHW. The President's Comprehensive Health Reform Program . Washington, DC: White House; 1992;:69-77.
18 +
Barer ML, Evans RG.  Interpreting Canada: models, mind-sets, and myths. Health Aff . 1992;;11:44-61.
19 +
Jackson Hole Group. The 21st-Century American Health System: A Proposal for Reform . Minneapolis, Minn:InterStudy; 1992;.
20 +
Stenholm CW, Cooper J, Andrews M. Proposal of the Conservative Democratic Forum's Task Force on Health Care Reform (The Accountable Health Plans and Managed Competition Act of 1992) . Washington, DC: US House of Representatives; 1992;.
21 +
Glaser WA. Health Insurance in Practice . San Francisco, Calif: Jossey-Bass; 1991;.
22 +
Roemer MI. National Health Systems of the World . New York, NY: Oxford University Press; 1991;.
23 +
Glaser WA. Health Insurance Bargaining . New York, NY: Gardner Press; 1978;.
24 +
Glaser WA.  Lessons from Germany. J Health Polit Policy Law . 1983;;8:359-361.
25 +
McCormick B.  'Any willing provider' laws are a key reform issue. Am Med News . (June 7) , 1993;:3, 30.
26 +
Glaser WA. Paying the Hospital . San Francisco, Calif: Jossey-Bass; 1987;.
27 +
Coulam RF, Gaumer GL.  Medicare's prospective payment system: a critical appraisal. Health Care Finance Rev . 1991;;12( (suppl) ):46-53,61-63, 69-72.
28 +
Brown ER, Dallek G.  Changing health care in Los Angeles.  In: Ginzberg E, Berliner H, eds. Changing US Health Care: A Study of Four Metropolitan Areas . Boulder, Colo: Westview; 1993;.
29 +
Robinson JC, Luft HS.  Competition, regulation, and hospital costs: 1982 to 1986. JAMA . 1988;;260: 2676-2681.
30 +
Glaser WA.  How expenditure caps and expenditure targets really work. Milbank Q . 1993;;71:97-128.
31 +
Starr P, Zelman WA.  Bridge to compromise: competition under a budget. Health Aff . 1993;;12 ( (suppl) ):7-23.

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