Abstract
THE YEAR 1988 is an auspicious time to take stock of US health policy. It is just 25 years since the federal government acted vigorously to expand the number of medical school graduates by an order of magnitude. It is 20 years since the Congress first became aware that the costs of Medicare would far exceed the original estimates with which it had reckoned and accordingly eliminated the 2% override in reimbursements to hospitals. And 1988 saw the first significant increase in Medicare entitlements when the President signed into law the catastrophic insurance bill. This longer retrospective emphasizes the extent to which earlier expectations have been fulfilled or, alternatively, undermined by later events. The increase of more than 60% in the ratio of physicians to population, from 140 to 233 per 100 000 (1960 to 1988) (Bureau of Health Professions, Health Resources and Services Administration, US Department of Health and
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