Health Care Access

In America, access to quality health care is currently available only to those who have good health insurance, either because their employers provide it, or because they can afford to purchase it independently. However, the United States faces a serious problem that promises to get worse: the inability of many residents to gain access to needed health care, primarily because of cost.

Patrick and Erickson (1993) state the problem in socioeconomic terms: "Although geographic, cultural, and educational barriers limit access to care, financial barriers dominate. Poor people, near-poor people, and persons with chronic illness--especially those without public or private insurance--find it difficult to obtain health care services (p. 333). The scope of the problem is especially apparent in view of the fact "the United States is the only industrialized country other than South Africa in which the public (government-financed) sector share of health care is less than 60 percent . . . health care is, in fact, a very big business--the nation's third largest industry (Reagan, 1992, p. 14). Instead of offering blanket coverage on the basis of citizenship, "the United States offers access to health services mainly on the basis of age, income, and employment" (Fox, 1993, p. 78).

The bleak setting described above will continue to perpetuate the rationing of health care services, and social service agencies which provide social safety nets for those in need will continue to operate on

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he strongest social service agenda. His favored plan is then assessed according to its implications for the social worker. Of the three proposals discussed--the Russo bill, the Senate bill, and the Pepper Commission Report--only the Russo bill presented a comprehensive reform proposal (p. 20). Of the three proposals discussed, only the single-payer system represented by the Russo bill held the prospect of comprehensively reforming the American health care system to control costs and provide a system of universal access at no additional cost to the nation's economy. This is the standard by which President Clinton said he would either sign or veto such a bill. Scuka (1994) outlines the bill, and compares it to the Canadian system: The Russo bill would leave the actual provision of health care in the hands of independent physicians and institutional health providers. In this respect the Russo bill parallels health care practice under the Canadian system in that neither calls for the review of specific clinical decisions, but both allow physicians to continue determining their own practice patterns (p. 23). For the first time, Americans would have a truly integrated national system of care, one that sets goals, establishes prior

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