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CMAJ • July 23, 2002; 167 (2)
© 2002 Canadian Medical Association or its licensors

Review
Synthèse

The US health care system: On a road to nowhere?

Jonathan Oberlander

Dr. Oberlander is with the Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC

Correspondence to: Dr. Jonathan Oberlander, CB#7240, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7240, USA; fax 919 966-7499; oberland{at}med.unc.edu

Abstract

THIS ARTICLE REVIEWS THE CURRENT STATE AND FUTURE PROSPECTS of the health care system in the United States. The 1990s were a decade of reform and change in US medical care, with the debate over the Clinton plan for universal insurance and, after its defeat, the spread of managed care. In particular, managed care had a profound impact on the delivery of medical services, transforming traditional insurance arrangements. However, after all of the changes, the United States appears to be no closer to solving the problems that have characterized its health care system for the past 3 decades. Over 40 million Americans lack health insurance, universal coverage is nowhere in sight, and medical care costs are rising again after a period of moderation. It is doubtful that incremental health reforms will significantly ameliorate these problems.




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