Archives of Internal Medicine
May, 2002
by Steffie Woolhandler, MD, MPH and David U. Himmelstein, MD
In the 35 years since the implementation of Medicare and Medicaid, a welter of patchwork reforms has been tried. Health maintenance organizations and diagnosis related groups promised to contain costs and free up funds to expand coverage. Billions of dollars have been allocated to expanding Medicaid and similar programs for children. Both Medicare and Medicaid have tried managed care. Oregon essayed rationing in its Medicaid program, Massachusetts and Hawaii passed laws requiring all employers to cover their workers, Tennessee promised nearly universal coverage, and several states have implemented high-risk pools to insure high-cost individuals. For-profit firms pledged to bring business-like efficiency to running HMOs, hospitals, dialysis clinics, and nursing homes. And market competition has roiled health care’s waters.
None of these initiatives has made a dent in the number of uninsured, durably controlled costs, or lessened the inexorable bureaucratization of medicine.
National health insurance could solve the cost-vs-access conflict by slashing bureaucratic waste. It would reorient the way we pay for care, and eliminate financial barriers to access. National health insurance could restore the physician-patient relationship, offer patients a free choice of physicians and hospitals, and free physicians from the bonds of managed care.
How many more failed patchwork reforms, how many more patients turned away from care they cannot afford, how many trillions of dollars squandered on malignant bureaucracy, before we adopt the only viable solution: NHI?