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Ann Thorac Surg 2007;84:1435-1446. doi:10.1016/j.athoracsur.2007.07.082
© 2007 The Society of Thoracic Surgeons
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Ethics in Cardiothoracic Surgery

Our Health Care System at the Crossroads: Single Payer or Market Reform?

David U. Himmelstein, MDa, Steffie Woolhandler, MD, MPHb, John C. Goodman, PhDc, Robert M. Sade, MDd,*

a The Department of Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts
b Physicians for a National Health Program, Chicago, Illinois
c National Center for Policy Analysis, Dallas, Texas
d Department of Surgery and the Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina

* Address correspondence to Dr Sade at Department of Surgery, 96 Jonathan Lucas St, Ste 409, PO Box 250612, Charleston, SC 29425. (Email: sader@musc.edu).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

The first 300 words of the full text of this article appear below.


   Introduction
 
Robert M. Sade, MD
In the 1940s, two decisions by federal agencies laid the foundation for the employer-based health care financing system that has characterized United States (US) health care for the last 60 years: the Internal Revenue Service’s designation of funds paid by employers for employees’ health care as tax-deductible and the Federal Trade Commission’s acceptance of health care benefits as bargaining chips in labor-management negotiations. The health insurance industry that has grown out of that foundation has many strengths and weaknesses. Public discourse over the last half century has focused on the weaknesses, a long list that is topped by lengthy periods of double-digit inflation that is well above the inflation rates of other goods and services and an increasing number of uninsured individuals—now more than 45 million, about 15% of the nation’s population. Attempts to address these problems through legislative remedies have produced only limited successes, and the problems continue to grow.

Many believe that the piecemeal legislation of the last 60 years is doomed to failure, and that lasting improvements in the health care system can be achieved only through radical change. Two fundamentally different approaches to health care reform have dominated policy discussions in recent years: creation of a centrally organized system designed to ensure that every American has health insurance versus devolution of our heavily regulated health care financing system toward a minimally regulated free market in health care.

Politically, the last major attempt to create a centrally organized system at the national level was the Health Security Act of President Bill Clinton’s administration in 1993–1994. The first important modern step toward a free market approach to health care was embodied in the Medicare Prescription Drug Improvement and Modernization Act of 2003, which created Health Savings Accounts. Further movement toward market reforms, such as refinements of Health Savings . . . [Full Text of this Article]


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This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
R. M. Sade
Ethical Foundations of Health Care System Reform
Ann. Thorac. Surg., November 1, 2007; 84(5): 1429 - 1431.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. Mayer
The American Health Care System and the Role of the Medical Profession in Solving Its Problems
Ann. Thorac. Surg., November 1, 2007; 84(5): 1432 - 1434.
[Full Text] [PDF]


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