The United States needs a health system like other countries
W. A. Glaser
Department of Health Services Management, New School for Social Research, New York, NY 10011.
Every developed country except the United States has a comprehensive health
system for coverage, service provision, and finance. Social policy in the
United States once was guided by thinkers who realized this, and the Social
Security system--complete except for health insurance--resulted. The
climate of thinking changed, and health policy for some time has been
dominated by classical economists who argue that free competitive markets
will solve all problems. They justify their arguments by claiming that the
only alternative is full government takeovers of service and financing, as
in Canada. While this debate has dragged along, problems in the United
States have become grave. Instead of reviving the institutional economics
and social policies that once served the United States well, the Clinton
administration has turned policy over to devotees of managed competition.
But the problem is how to organize the country, and national health
insurance--easily observed in other countries--is superior to the current
chaos and free-market utopias in the United States. Important aims would be
achieved, such as expanding coverage, obtaining stable revenue, and
containing costs. Important political barriers can be overcome, such as
resistance by small business. Such a health system includes machinery for
setting goals and implementing results, involving collaboration among
providers, payers, and government.
