A century of health care reform

Jon Oberlander’s latest in NEJM is a handy guide to the history of U.S. health reform. It includes a nice timeline in chart form. (All ungated.) Here are a few bits I highlighted as I read:

  • “If we had a parliamentary system, the United States probably would have adopted universal insurance decades ago.”
  • “The United States has moved through fads at a dizzying pace in recent decades — from managed to consumer-driven to accountable care — but they have thus far failed to produce reliable cost control.”
  • “U.S. health policy has also been an abject failure, having produced an inequitable, inefficient system that is the most expensive in the world and that leaves 20% of the nonelderly population uninsured. Health insurance should be a source of security and reassurance. The U.S. insurance system is too often a source of suffering, anxiety, economic insecurity, and frustration.”
  • “That these and other indignities have persisted so long is an indictment of U.S. health policy and its moral quality. If there is one thing we should learn from the experiences of other countries that have universal coverage, it is that it doesn’t have to be this way. None of these problems are natural or inevitable — they are all the result of policy choices that the United States has made.”


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