Download Health Care Reform: Why

Health Care Reform: Why? What? When?
Victor R. Fuchs
Stanford University
Abstract
Dissatisfaction with the U.S. health care system is widespread, but no consensus has emerged as
to how to reform it. The principal methods of finance – employer-based insurance, means-tested
insurance, and Medicare – are deeply and irreparably flawed. Problems also plague the
organization and delivery of care – inefficient scale, inadequate quality control, and inattention to
benefit-cost tradeoffs. Two fundamental questions face policymakers: Should reform be
incremental or comprehensive? Should priority be given to reforming the financing system or to
improving organization and delivery? What approach to reform will be most effective in dealing
with the major problems of the system? What approach is most congruent with basic American
values? Prospects for significant reform in the near term are virtually zero for many reasons:
political, social, and economic. Over the long term, reform is likely to come in response to a
major war, a depression, or large scale civil unrest. Other possible factors that might precipitate
significant reform are disenchantment of the business community with employer-based
insurance, the inability of states to bear the financial burdens of means-tested programs, the
financial collapse of Medicare, or a public health crisis such as a flu pandemic.