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Perspective
Volume 358:325-327 January 24, 2008 Number 4
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The Amazing Noncollapsing U.S. Health Care System — Is Reform Finally at Hand?
Lawrence D. Brown, Ph.D.

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Amid the myriad social transformations, corporate reorganizations, and policy innovations that have shaken the U.S. health care system, one great, puzzling constant endures. For roughly 40 years, health care professionals, policymakers, politicians, and the public have concurred that the system is careening toward collapse because it is indefensible and unsustainable, a study in crisis and chaos. This forecast appeared soon after Medicare and Medicaid were enacted and has never retreated. Such disquieting continuity amid change raises an intriguing question: If the consensus is so incontestable, why has the system not already collapsed? Perhaps pondering this question can yield insights into . . . [Full Text of this Article]


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Dr. Brown is a professor in the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York.



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