Abstract

How to reform the American health care system, now dominated by a decreasing number of multi-billion dollar managed care corporations, has occupied the public debate for many years. Recent news reports hefty increases in managed care premiums, benefit reductions, and an ever-growing number of managed care organizations refusing to treat Medicare patients. Numerous “patients’ bills” have been submitted in Congress, attempting to rein in some of the managed care cost containment practices. None have been adopted so far. At best, such bills would superficially treat some of the symptoms of an ill-functioning health care delivery system, poorly serving the population, insured and uninsured, and creating a plethora of ethical conflicts for providers battling to preserve an acceptable standard of care. Since the Clinton health care reform efforts failed in 1994, no one has proposed a fundamental revision of the system, and the United States remains the only industrialized nation without a universal health care system. The literature mainly reports on those – English-language – countries whose cost containment measures have resulted in overburdening the public health care system. There are, however, numerous European governments which succeed in stabilizing health care expenditures by mandating some sacrifices by all participants in the health care system while preserving universal access, comprehensive coverage, and the standard of care.

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