After reviewing the record of health planning in the United States over the twentieth century, what I find most striking is the high level of consensus present among the majority of those concerned (consumers, providers, vendors, evaluators, and such) regarding the need for major changes in current health care delivery arrangements. Equally striking is the complete lack of consensus past this point when it comes to identifying the problem and its solution. This situation is clearly illustated by public survey data showing that a majority of the public considers the health care system to be in a state of crisis and that there is little consensus regarding the aspects that should be changed. In my estimation, the persistent perception of a health crisis stems from society's lack of confidence in the social control arrangements governing the activities of the health sector in recent years; what is worse is that the public is confused about who should be entrusted with the responsibility for planning the nation's health ( Mead 1977). The primary reason for the confusion is the paucity of information to assist in altering the current situation ( Ermann 1976). This is not to say that the relevant information does not exist; however, the existing information is poorly organized, inaccessible, and uneven. In actuality a great deal of information is being generated, but it is often disseminated in a way that adds to the public's sense of confusion ( Evans 1983).
This chapter consolidates a portion of the vast amount of information available in the hope of reducing some of the confusion surrounding current discourse regarding the problems affecting the health sector. (For another perspective see the APHA Presidential Address, Addiss 1985.) The discussion presented here begins with a review of the topics addressed in preceding chapters. Outlined is the sequence of steps responsible for the design of the health care delivery system that now exists. Then the evidence available on the performance of the mech-