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Raymond H. Murray, MD

JAMA. 1975;234(3):287-288.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

THIS country's unexpressed health policy is, and really always has been, muddling through—a strategy of free-floating expediency, responding capriciously to the pressures and passing fancies of the health establishment, social zealots, health planners, and budgeteers. It is practiced regularly by politicians who have a penchant for brush-fire planning and hastily designed programs that serve to cover over health problems with boundless money and immature ideas. It is the favorite method of pragmatic administrators and bureaucrats who must manage complicated health organizations without goals or guidelines—where the "right" decision is not known or even knowable, or if knowable might not be implementable.

This policy has caused factionalism to flourish and made planning impotent. One of its most visible consequences is the endless output of new health legislation—a kaleidoscopic jumble of mismatched efforts. Another is an ever-expanding bureaucracy, since established programs never die and hardly ever fade away. The most unsettling outcome . . . [Full Text PDF of this Article]

Author Affiliations
Indianapolis

From the Department of Community Health Sciences, Indiana University School of Medicine, and the Regenstrief Institute for Health Care, Indianapolis.

Footnotes
Reprint requests to Department of Community Health Sciences, Marion County General Hospital, 960 Locke St, Indianapolis, IN 46202 (Dr Murray).

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