Four years ago, the country was on a course leading to ever increasing commercialization of health care, rising numbers of uninsured, and a deteriorating health care safety net for vulnerable populations. Congress took a look at the road ahead...and stamped on the accelerator. The resulting crisis poses difficult dilemmas for all who cherish a compassionate vision of health care.
American health policy has always been distinguished by its treatment of health care as primarily a commercial good, to be bought and sold like other market commodities. (In all other industrialized nations, health care is regarded more as a social good, like public education or fire protection, to be afforded the whole population.) Therefore, despite the fact that the health care industry is more heavily subsidized by government in the United States than in Britain, we tend to regard government regulation of the industry as illegitimate interference with private markets. This muddled public perception has repeatedly thwarted efforts at reform.
In 1994, President Clinton's Health Security Act died an ignominious death in a Democratic Congress, as tepid popular support was easily overwhelmed by entrenched financial interests. Corporate America, having blocked government action, is itself transforming the health care system. The scope and depth of change has been largely overlooked by the media, which tend to focus on government policy debates and underestimate the public effects of private economic decisions. Change is occurring through the growth of for-profit managed care, conversion of public and non-profit health resources to for-profit ownership, and the consolidation of health care providers into ever larger corporate entities. The health industry is booming as never before: Last year was the most profitable ever for the hospital industry.