Thinking Clearly About the Issue of Health Insurance

Abstract

again, issues of health insurance are figuring prominently in a presidential election campaign, with the candidates' proposals subject to microscopic dissection in the popular and trade press alike. The problems those proposals purport to address the growing number of Americans without health insurance, whose access to health services is thus significantly compromised; growing out-of-pocket costs for increasing proportions of those who are nominally insured in a time of stagnant real incomes and growing expenses for food, housing, and fuel; increased costs for everyone are surely serious enough, and deserving of political attention and, more importantly, of policy action. Many of those specific problems are discussed with creativity and insight in the articles that make up the bulk of this Special Theme Issue of Medical Care. But the broader issues underlying the political debate, and even the likelihood of effective action by a new administration to address these issues, are increasingly obscured by confusion as to what health insurance is, and should be, all about. We run a serious risk of solving the health insurance problem without adequately addressing the problems health insurance was invented to address, while leaving much of the population with compromised or inadequate access to the health care they need.