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

• 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
• ISSN: 1073-1105; 1748-720X
• DOI: 10.1111/j.1748-720X.1993.tb01239.x

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.