e sixty five, were left without catastrophic coverage, save what could be purchased in the private medical insurance market. Above all, the broader problems of Medicare, and of the American health care system in general, remained unresolved.
The catastrophic care coverage was in fact only one episode in an ongoing controversy over the effectiveness, nature, and future of American health care. The United States remains the only major industrial nation lacking in a comprehensive "cradle to grave" system of public health care or insurance (Marmor, Mashaw, and Harvey, 1990: 192). At the same time, the U.S. has the world's most expensive medical care system, accounting for nearly twelve percent of the Gross National Product in rough, round numbers, a staggering six hundred fifty billion dollars a year, or two thousand dollars a year for every American man, woman, and child. (The costs of medical care in other industrialized countries run from six to nine percent of GNP.) Yet the U.S. has surprisingly little to show for its expensive effort. Thirty to fifty million Americans have no health insurance coverage. The U.S. ranks nearer the bottom than the top of industrial countries in most measures of health and longevity.
The closest thing the U.S. does have to national health insurance is Medicare, a Federal program providing (incomplete) health care coverage for Americans age sixty five and over, which was established in the Great Society heyday of the 1960s. (Medicaid, a care system oriented towards the poor, was established at the same time; its problems resemble those of Medicare, but as might be expected are more severe.)
Medicare is thus only one part of the overall American health care system, but it is the only part which has some of the characteristics of national health insurance. Also, because the elderly are the largest "consumers" of medical care and services, Medicare is, for all its...