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U.S. Health Care Coverage and Costs: Historical Development and Choices for the 1990s

Published online by Cambridge University Press:  01 January 2021

Randall R. Bovbjerg ,
Charles C. Griffin  and
Caitlin E. Carroll
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Extract

American health policy today faces dual problems of too little coverage at too high a cost. The mix of private and public financing leaves about one seventh of the population without any insurance coverage. At the same time, the coverage Americans do have costs an ever-larger share of our country’s productive capacity. The U.S. pays well above what other countries pay and what many people, health plans, businesses, and governments want to pay. This “paradox of excess and deprivation” results from the incremental approach the U.S. has taken to promoting incompatible policy goals of increasing health insurance coverage and medical quality while trying to control costs, without squarely confronting tradeoffs. This essay examines the record of incremental developments and draws lessons for current efforts at reform.

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Article
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Journal of Law, Medicine & Ethics , Volume 21 , Issue 2 , Summer 1993 , pp. 141 - 162
Copyright
Copyright © American Society of Law, Medicine and Ethics 1993

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References

The writing of this paper was funded by The Urban Institute. It draws on practical experience in state insurance regulation (R.B.), as well as on numerous research projects in private and public financing for medical services, both in the U.S. (R.B., C.G., C.C.) and overseas (C.G.). The support of many funders for these projects is gratefully acknowledged, but the authors remain solely responsible for the content of this paper. The paper’s conclusions and opinions do not necessarily reflect anyone else’s views, including other staff members of the Urban Institute or the World Bank, their officers, trustees, and advisory groups, or any organizations that provide financial support. The authors thank Eileen Nowacki for her data input and other support and Ella Hornsby for additional assistance.Google Scholar
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