Thoughts on a New Government Role in Health Care
Robert L. Kane
Some years ago, my wife and I set out a framework to describe the potential roles of government in providing health and social services in an alliterative format using the letter P ( Kane and Kane 1981). These roles consisted of planning, providing, purchasing/paying, policing/protecting, preparing (training), promoting, and policy making. It seems appropriate to revisit this list today, more than a decade later, to see how government has responded to current social and economic conditions and what its options now appear to be. 1
Recent political changes have challenged the central role of government in influencing the shape of health services. As government becomes a party of last resort instead of first resort, many things change. The initiative shifts to other sectors and the principles of accountability become more passive than active. This change in emphasis from government to business seems to be cyclical ( Reich 1987). It seems to be based less on empirical observation than on philosophic preference. Its implications are profound.
Historically, government has played an active role in setting goals for health care and establishing strategies to meet them. Health statistics are monitored. More recently, the federal government has gone through an elaborate planning effort, Healthy People 2000 ( U.S. Department of Health