Conflicting aims. Voluntary health insurance and contemporary medical practice

American medicine is financed today by a patchwork of systems formed around a concept of competitive voluntary health insurance that evolved over the past 50 years. This article reviews the theory of health insurance from a clinical perspective to examine whether changes in medical science and practice have made such an insurance system obsolete. As it is currently applied, a system of competitive voluntary health insurance conflicts with the goals of modern medical practice due to advances in screening and in treatment and the need to deal more effectively with paying for care of unknown efficacy. Proposals to reform health insurance must deal with the medical failings of competitive voluntary health insurance and should do more than simply extend the current system to cover more Americans.