From a technical perspective, the quality of health care in the United States is unmatched in the world. Its physicians and other medical professionals are well trained, its hospitals and clinics well equipped with the latest sophisticated equipment. The US is the world leader in the introduction and application of new medical technologies, from laser surgery to pharmaceuticals. People from around the world come to the United States for new or specialized medical procedures. The techniques and organization of emergency response to accidents and other trauma, originally developed for wartime medical evacuation, are also exceptionally well developed.
From the perspective of actual health care delivery, however, the picture is far less favorable. The United States is nearly alone among the developed industrial nations in lacking a national health insurance system. The existing system of private insurance, provided largely by employers, is badly broken.
Some 40 million Americans lack health insurance entirely. Unable to obtain routine medical care, their conditions often deteriorate until they are forced to go to emergency rooms, burdening the emergency care system with problems that could have been dealt with earlier and at vastly lower cost in a doctor's office or clinic. Other health conditions are never properly treated, with the result that the US has poorer mortality and life expectancy statistics than most other developed nations.
Even for those who have health insurance, conditions have been deteriorating. Until the 1980s, employer health plans tended to be comprehensive. As medical costs began to rise, far outstripping the general rate of inflation, employer health plans were trimmed back. Comprehensive coverage gave way to "menus," while copayment premiums and deductables were increased.
In the 1990s, consumers were increasingly pressured into shifting from traditional fee for service care in...