Health policy in the land of Oz

Since the mid-1960s, the health sector has depended on the political process to shape the organization, delivery, and financing of medical care. When the health sector was in its infancy, using public policy to give form and substance to America's medical care was appropriate. Now, after nearly 35 years of legislative activity at the federal and state levels, American health care has become expensive, fragmented and complex-and the political process gridlocked. Can the necessary health reform efforts be stripped from an ineffective, politicized public policy process, and be accomplished from the bottom up by disenfranchised purchasers and providers of health care and their communities acting on their own initiative?