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Leading policy-makers and scholars explain how market forces, deregulation, and consumer choice can work to improve health care for all Americans.

Commentary

What ails health care
David Gratzer, The Public Interest, 4-1-05

Gratzer, a senior fellow at the Manhattan Institute, has written a short but panoramic history of American health care from World War II to the present. What he finds is that America's health care system is driven by third-party coverage (employer or government based) that labors under an ever growing list of state and federal regulations. As a result, costs steadily escalate even as individuals grow more resentful of the system. Gratzer concludes that the key missing component of American health care is consumer choice.

While the American healthcare system has gone through much "reform," relatively little of its overall economics has changed. Reform, thus, has largely been an exercise in shifting costs from payer to patient, from insurance plan to hospital, from hospital to physician, from uninsured to insured. Since the 1970s, much has been made of the idea of managing care-but really, these have been exercises in managing cost. For most Americans, the end result has been less control over basic health-care decisions, a prescription for universal dissatisfaction.

If we really want to address the system's shortcomings-to tame health inflation and broaden coverage-a new approach is needed. We must recognize that the structure of American health care is flawed, and we must seek to address this by giving people more control over their own health care.



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