Doctors have patients, governors have citizens.

Abstract

PREFACE: The word “system” suggests a set of activities that come together in a reasonable fashion. If not seamless, they are at least end to end—the interstate highway system, the air traffic control system. The absence of a national health care system in the United States has produced a landscape replete with inconsistencies, redundancies, and—most problematic—gaps. Health care in this country, however, is not without systems. Multiple subsystems exist, governed by public laws and private insurance arrangements. These contending and competing systems collectively determine the size of the health care pie in the country and, effectively, divide it up. Any efforts to reform or coordinate these systems must start with the logic that created them rather than with the sometimes irrational results they generate. Richard Lamm, former governor of Colorado, sat atop a state system for twelve years. The systematized inequities he encountered during his tenure have made him an articulate campaigner for distributional reform in health care. IreneWielawski dissects systems on a more personal level. She writes about the discounted rate her medically insured family was charged for her son's hernia repair, compared with the apparent price gouging encountered by an unnisured man trying to get his hernia repaired in order to work. Both essays probe important systematic inconsistencies.