Problem of Uninsured & Under-Insured People

It is generally agreed that America is facing a crisis in health care occasioned by the rising costs of providing health care along with an increase in the number of people who are either uninsured or under-insured. Some see this as a problem rather than a crisis, but even they usually do not deny that the public sees the problem as acute. The problem has become a major political issue and played a significant role in the last presidential election, and it remains high on the political agenda as the public waits to see what the Clinton administration and Congress will do about the problem. There are major arguments over what that proposal will entail, how it will be funded, and what its prospects for passage might be. The insurance industry is concerned about the nature of the health care system that will be developed and is own role in that new structure. The industry has its own proposals for the reform of health care and sees many of the proposals now being discussed as draconian and even punitive toward the health insurance industry. The outlook for the future of the industry remains in doubt as these issues are debated. An analysis of the issue and of the possible proposals to be made by Clinton can illuminate the nature of the issue, the scope of it as a problem, the range of solutions that have been suggested, and some of the possible provisions that might be adopted in the coming years.

In a recent editorial in the Journal of the American Medical Association,

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wing the different groups involved and the ideological and practical differences among them. One was offered by Senate Republicans, another by House Republicans, and a third by a group organized around Senator Phil Gramm and taking its own route to health care in opposition to the Clinton Plan. Congressional Republicans differ in degrees on three major issues--whether reform should be incremental or comprehensive, whether the new health care system should be employerbased or individualbased, and whether to go with managed competition or a less regulated freemarket model. They also differ on how much government control is needed and whether new taxes should be levied. Moderates stress universal coverage, and conservatives stress cost control. Republicans generally agree in opposing Clinton's proposals for global spending limits and a mandate on employers to pay for workers' coverage. One clear reason why the Republicans have been trying to develop a health care initiative is the showing in polls that their constituents want such a plan (Meyer, 1993a, p. 23). Republican thinking about system reform has been strongly influenced by the Heritage Foundation's consumerchoice proposal that would replace employerprovided t

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