Health care reform: who will lead?

The United States is almost alone among industrialized nations in failing to assure access to at least some health care for all of its citizens. Three major obstacles impede the provision of universal access. First is the deeply embedded sense among our citizens and in our health care system that some persons are more deserving than others of care. Second is a focus on costs and reimbursement mechanisms rather than on defining effective and appropriate care. Third and most serious is an absence of leadership in addressing the problems of access and of reform in the U.S. health care system. In choosing among the possible leaders, which include the federal government, the states, the business sector, unions, and physicians, a compelling argument can be made that physicians should lead, particularly in defining effective and appropriate care. Physicians may also lead in redesigning the health care system, but they are likely to be only one interested voice in the debates about financing health care.