Ten years after Bill Clinton won the presidency on a platform that included a major overhaul of the American health care system, nearly 40 million Americans have no health insurance, businesses are shifting the costs of medical care to their employees, hospitals and physician groups are seeking bankruptcy protection from the courts, and senior citizens are taking bus trips to Canada to try to buy essential medications at affordable prices.
The new president of the American Psychiatric Association, Paul S. Appelbaum, M.D., took office with the admonition, "The moral obligation of a just society to provide for the needs of the less fortunate, as we would want our needs met were we in their places, teeters on a precipice."
Charles Kolb, president of the Committee for Economic Development, a nonprofit, nonpartisan business group, told reporters in Washington, D.C., "The problem is not a lack of good intentions, but a series of structural flaws," as the group issued a report titled A New Vision for Health Care: A Leadership Role for Business.
But the nation's political establishment, burned by the failure of the Clinton health proposals in 1994, shies away from directly confronting the challenges of fixing the system. Instead, it prefers to nibble around the edges with plans for a partial subsidy of prescription drugs for Medicare recipients, a so-called patient bill of rights aimed at protecting consumers from the worst excesses of managed care, debating parity for behavioral health care and tinkering with targeted programs aimed at at-risk populations such as children.
"It is still a shameful fact that some 39 million Americans--men, women and children--do not have health insurance," wrote syndicated columnist Helen Thomas, "and although a number of organizations have begun an effort to get [U.S.] Congress to move on the subject, there is no chance that will happen this year."
"A sober recognition has settled in Washington that little can be done to expand or improve health coverage while health care costs spiral out of control and the federal budget sinks deeper into deficit," a New York Times editorial cautioned in May. "Lawmakers seem to be betting that voters will not punish them for inaction. But they cannot put off the issue forever."
"In American politics, the structure of government makes it hard to get a majority on anything, except war," Theodore R. Marmor, Ph.D., professor of public policy and management at Yale School of Management, told Psychiatric Times. "When we have elections, we don't elect the government, we elect people in the government."