Future directions in national health policy for the United States

Unlike other countries which have established some form of national health insurance, the United States is debating this profound social program in facing all problems of financing and managing personal health services simultaneously: elimination of cost at time of service, sharing this cost equitably through the tax system, distributing the services equitably goegraphically, controlling rapidly rising costs and managing the organizational structure of services. Originally in other countries the primary objectives were to free citizens of the burden of costly illnesses, improve access across income groups, and share the costs more or less equally. Now other countries are expressing the problems found simultaneously by the United States. It is argued that universal and comprehensive national health insurance spreads money and resources so thinly that specific and important problems such as pockets of high infant mortality or curable diseases are obscured and ignored. The United States sould set up a health program which targets specific problems and mitigates high cost episodes rather than indulge itself in a comprehensive and universal national health insurance. This proposal is not politically feasible, however, and predictions are made as to what will happen in the United States within the politically and culturally determined range of debatable options.