Applying brakes to the runaway American health care system. A proposed agenda

The American health care system, and especially its cost, is out of control, inhibiting access to care for many, lessening quality of care for some, and creating an almost palpable angst among physicians and others concerned with this enormous national problem. Increased health care rationing in the next decade is inevitable, yet it must not be done with quick fixes, short-term solutions, and patchwork reform of our present system. That would create worse problems for health care in the 21 st century and is clearly unacceptable. We recommend that President Bush appoint a blue-ribbon commission to study our present system in depth, then offer alternative solutions for its many problems. He should look closely at at least the following nine issues: controlling medical technology, instituting a resource-based relative value system for physician reimbursement, establishing an ongoing national medical ethics commission, instituting national malpractice reform, implementing universal medical coverage with Medicare/Medicaid reform, establishing a national health services research and planning institute, reducing the nation's health care facilities, reducing physician supply, and improving health promotion/disease prevention education.