4 Health Care Reform: The Clash of Goals, Facts, and Ideology

In 1994, the United States engaged in a great, if confused, national debate on how to modify financing and delivery of health care. Despite general satisfac-tion with the quality of care they receive, Americans tell poll takers that their health care system is badly awry and in need of fundamental change. While in seeming agreement that something needs to be done, the public and health care experts alike seem confused and divided on just what to do. 4.1 Why Consensus Is Elusive The sources of disagreement are several. First, a major goal of health care-the ability to enjoy high-quality life as long as possible-is not very well de-fined and is affected more by the external environment, personal behavior, and genetic inheritance than by health care. As a result, discussion of health care finance often loses focus when observers point out-correctly-that health gains from reform of health care financing will be small unless violence is controlled, housing upgraded, diet improved, drug abuse curbed, or some other change in the social environment or personal behavior achieved. It is certainl