Democratic Values and Health Policy Reform
Throughout the 20th century, in roughly 20-year intervals, the vision of a universal health care system has risen to the national public policy agenda and has been defeated by a powerful coalition of groups with a vested interest in maintaining the status quo. 1 Today fundamental reform in health care service delivery and financing is back in the policy arena once again, but there are signs that the historic coalition preventing such reform is no longer in place. The American Medical Association, traditionally a leading opponent of systemic change, has officially sponsored a plan to achieve universal coverage that departs in many, if not all, respects from positions organized medicine has taken in the past. 2 Large corporations find their health care insurance costs rising rapidly and have begun to press for cost-containment measures and for controls that will restrict the cost shifting that has traditionally occurred to enable hospitals to support indigent care. The hospital industry, in turn, finds its own interests compromised by uncompensated care. Insured workers find their out-of-pocket costs increasing as their employers impose large deductibles and copayments and increase the cost of family coverage. 3 The elderly also find their medical expenses increasing as a financially strapped Medicare program increases their share of costs and as the cost of such items as prescription drugs rises.