There is widespread consensus that the
American health care system underperforms relative to the resources it has available,
and that gaps in financing and service delivery pose major barriers to improving
health, achieving universal insurance coverage, enhancing quality,
controlling costs, and reducing disparities. In addition, while the health care system
generously allocates resources to medical services, it devotes far fewer resources
to prevention activities and promoting healthier living or lifestyles.
Many of the issues facing the American health system today flow from the
enterprise itself, such as advances in technology and science, uncertainty about
treatment effectiveness, the explosion of information and its accessibility, and growing
demand for services. Other problems reflect American government and
policymaking, our distinctive individualistic and activist culture, and our ideological
conceptions about health and health care provision. Still others relate to the larger
social and economic context, the corporatization and privatization of health care,
and difficulties in making medical markets work. Finally, some issues derive from
our distinctive history and the history of the medical and other health professions
as they compete for autonomy, authority, and public trust.