What Are the Main Issues?

Public discussion in recent years indicates widespread concern about the quality and distribution of health services in the United States. Five principal problems are generally recognized

  1. How to arrange payment so that all the people can regularly pay specified amounts in accordance with their earnings rather than, be burdened irregularly and unexpectedly with the large costs of unpredictable illness.
  2. How to pay for medical services and facilities so that they can be available more evenly throughout the country.
  3. How to organize America’s health services to use our medical resources most effectively and furnish service of high professional quality.
  4. How to make necessary changes and yet preserve the best of our present medical practice, avoid undesirable and arbitrary governmental controls, and guarantee freedom within the program for both patients and physicians.
  5. How at the same time to stimulate continued and improved medical education and research.

Although there is much disagreement as to how it should be done, most groups of the professions and the public appear to agree on the basic principles that people can more easily pay for medical service by some type of insurance than by the traditional fee-for-service method; that federal funds from general taxation will be needed if hospitals and other facilities are to be built in needy areas; that medical services can be supplied more economically and with better guarantee of quality by the use of group medical practice than by individual practice; that local representatives of the professions and the public must control the distribution of services on the basis of broad national standards; and that national funds will be needed to support improved and extended medical education and research.

Controversy has been most pointed about the proper role of government in any changed organization of health services. Opinions range from those who would limit government aid to specific problems-such as sanitation, communicable disease control, the care of the needy, institutional care for mental illness and tuberculosis-to those who would have government, particularly the federal government, take steps to assure adequate health and medical services to all.