U.S. Health Care Coverage and Costs: Historical Development and Choices for the 1990s

American health policy today faces dual problems of too little coverage at too high a cost. The mix of private and public financing leaves about one seventh of the population without any insurance coverage. At the same time, the coverage Americans do have costs an ever-larger share of our country’s...

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Bibliographic Details
Published in:The Journal of law, medicine & ethics medicine & ethics, 1993, Vol.21 (2), p.141-162
Main Authors: Bovbjerg, Randall R., Griffin, Charles C., Carroll, Caitlin E.
Format: Article
Language:English
Subjects:
Analysis
Bioethics
Federal Government
Forecasting
Health care costs
Health Care Costs - history
Health care expenditures
Health care policy
Health care reform
Health care services
Health Expenditures - history
Health insurance
Historical development
History
History of medicine
History, 20th Century
Humans
Insurance, Health - history
Medical care
Medical care, Cost of
Medically Uninsured - history
National Health Insurance, United States - history
Nursing
Reforms
United States
Voluntary Programs
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Summary:American health policy today faces dual problems of too little coverage at too high a cost. The mix of private and public financing leaves about one seventh of the population without any insurance coverage. At the same time, the coverage Americans do have costs an ever-larger share of our country’s productive capacity. The U.S. pays well above what other countries pay and what many people, health plans, businesses, and governments want to pay. This “paradox of excess and deprivation” results from the incremental approach the U.S. has taken to promoting incompatible policy goals of increasing health insurance coverage and medical quality while trying to control costs, without squarely confronting tradeoffs. This essay examines the record of incremental developments and draws lessons for current efforts at reform.
ISSN:1073-1105
1748-720X
DOI:10.1111/j.1748-720X.1993.tb01239.x