National Health Insurance and the Strategy for Change

Abstract

This paper sounds a note of caution that regardless of the type of national health insurance program Congress will approve from among the proposals now before it, the present defects in the organization of health services in the United States may be strengthened rather than alleviated. Consequently, the reorganization and redistribution of health resources required to secure the availability of care for the greatest possible number may be hindered rather than stimulated. Strategies for change based upon a market and incentives ideology, such as those implicit in the current proposals for national health insurance (as well as those in Health Maintenance Organization proposals), will necessarily be limited in their reorganizational and redistributive effects, inasmuch as they leave untouched the locus of economic and political power in the health sector; it is argued that this very locus of power precipitated the much-quoted medical care crisis. In order to achieve the necessary reorganization and redistribution of resources in the health sector, the author believes that the locus of power must shift from the private to the public sector, permitting the levels of federal, state, and local government to formulate a mechanism for national and regional health planning in which public agencies would be the ones primarily responsible for planning, regulating, and controlling (but not necessarily owning) the distribution of human and physical resources within the health sector. In the light of this recommendation, the present structure for national and regional planning in the United States is described and appraised.