200th Anniversary Article: Major Trends in the U.S. Health Economy since 1950

By Victor R. Fuchs, Ph.D
The New England Journal of Medicine, March 15, 2012

It is difficult to see how the health sector can continue to expand rapidly at the expense of the rest of the economy, but every past prediction of a sustained slowing of the growth of health expenditures has been proved wrong. Rapid growth may continue as a result of political gridlock regarding the form that curbs on expenditures should take. There is no public consensus about how much care should be provided for the poor and sick or how it should be done. Similarly, there’s no public consensus regarding efforts to increase the efficiency of care. A rational approach to the financing, organization, and delivery of care seems politically impossible. However, the observation by de Tocqueville that in the United States “events can move from the impossible to the inevitable without ever stopping at the probable” may prove to be prescient.

http://www.nejm.org/doi/full/10.1056/NEJMp1200478?query=TOC

Victor Fuchs tells us, “There is no public consensus about how much care should be provided for the poor and sick or how it should be done.” Why? We know that all health care reform efforts since 1950 have fallen short of our goal of health care for everyone. We know that a single payer national health program would provide all essential care for everyone. Why should this be politically impossible? Haven’t we already moved from the impossible to the inevitable? If so, let’s accept that and get to work on fixing our health care system so it takes care of everyone.