essed it as they should have in the past.
The problem itself has been well documented. In the last 15 years, the number of uninsured Americans has grown, and most estimates in 1991 place the number lacking public or private coverage at between 31 and 36 million. According to the 1987 National Medical Expenditure Survey, some 47.8 million people lacked insurance for all or part of 1987, and the U.S. Bureau of the Census found that from the first quarter of 1986 to the last quarter of 1988, 63.6 million people lacked coverage for at least one month and 31.5 million lacked it in the final quarter of 1988. In terms of age, those between 19 and 24 years of age are the most likely to be uninsured, and 20.3 percent of this group were uninsured for all of 1987 and another 18.2 percent for part of the year. Children under 18 years of age were the next most likely to be uninsured so that one in four were uninsured either all or part of the year. Of those aged 25 to 54 years, 19.8 percent were uninsured all or part of the year, and among those aged 55 to 64 the figure was 13.6 percent. This was particularly disturbing in that the people in this age group face a higher risk of serious health problems (Friedman 2491).
Numerous reform proposals had been offered by the time of these speeches. Among the proposals were a number that emerged from systems of managed care, including gatekeeping by a primary care physician, prior authorization and utilization review, assumption of financial risk through capitation payments to the provider with financial disincentives for hospitalization or referral to specialists, and so forth. Many saw the issue in terms of the rationing of health care, a term used in two different senses. First, market economies deny goods to those who cannot afford them, and this includes the good of health care. This is a form of rationing by price that has a long history in the United States, to the detriment of the p...