rospects for controlling expenditures over time. (Moore, 1991, p. 2108)
The scope of this problem is seen in the fact that more than 30 million Americans have no health insurance at all. While everyone agrees that this is a problem, no national consensus has emerged on what to do about it:
The major barrier to decision and change is fear: fear that the price tag to cover medical care for the uninsured will be too high and impossible to control. (Moore, 1991, p. 2108)
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, 1991, p. 2491).
Some segments of society have been affected more than others by this problem, and there seems to be not only an economic factor but also a racial and ethnic one. Racial and ethnic differences affect rates of coverage. According to 1987 figures, of non-Hispanic whites, 18.6 percent were uninsured for all or part of the year, as...