Debate on U.S. Health Care Reform MYTHS AS BARRIERS TO HEALTH CARE REFORM IN THE UNITED STATES

The U.S. health care system is deteriorating in terms of decreasing access, increased costs, unacceptable quality, and poor system performance compared with health care systems in many other industrialized Western countries. Reform efforts to establish universal insurance coverage have been defeated on five occasions over the last century, largely through successful opposition by pro-market stakeholders in the status quo. Reform attempts have repeatedly been thwarted by myths perpetuated by stakeholders without regard for the public interest. Six myths are identified here and defused by evidence: (1) “Everyone gets care anyhow; ” (2) “We don’t ration care in the United States”; (3) “The free market can resolve our problems in health care”; (4) “The U.S. health care system is basically healthy, so incremental change will address its problems; ” (5) “The United States has the best health care system in the world”; and (6) “National health insurance is so unfeasible for political reasons that it should not be given serious consideration as a policy alternative. ” Incremental changes of the existing health care system have failed to resolve its underlying problems. Pressure is building again for system reform, which may become more feasible if a national debate can be focused on the public interest without distortion by myths and disinformation fueled by defending stakeholders. As on many occasions over the last century in the United States, the issue of health care reform is again moving toward center stage on the nation’s agenda. There is growing recognition that the present system is sick, and many feel that structural reform is required. If one has any doubts about how critical is this juncture in U.S. health care, the Appendix (pp. 324–326) lists examples of some of its serious problems with respect to access, cost, quality, and overall performance of the current system (1–27)