Ensuring Health Care for the Uninsured

To the Editor. —Dr Weissman's review¹ of the role of uncompensated care in providing health care to the uninsured documents the growing fragility of the safety net. In the same issue, Dr Ginzberg² provides a much needed word of caution about the ability of market forces and competition to solve the chronic problems confronting our health care system. Each article underscores how far reliance on market reforms has moved us from the objective of universal access to health care. Together they portend a looming crisis and should serve as a wake-up call for renewed debate.

The number of uninsured persons is predicted to reach 45.6 million by the year 2002³ as traditional mechanisms to provide care to this population are eroding. The literature has consistently shown that the uninsured have worse health outcomes than the insured.⁴ As access to care becomes more problematic, existing inequities