This report provides a shrewd commentary on developments in recent health reform in the United States. The dream of comprehensive health insurance and a single tier health system died in 1994 with the defeat of the Clinton health reform plan. What survived was “the official embrace by the US Congress of an income-based health system that will ration health care quite severely for Americans assigned to the bottom tier and not at all for those in the upper tier”.
What the author described as an acceptance by the policy-making elite of “glaring inequities” in health care helps to explain why the system is able to experiment so boldly with new approaches to health insurance schemes and health care delivery. But the concept of ‘managed competition’ is leading to great turbulence in the American health care sector.