Ten testing questions: five years later.

Abstract

Five years ago, as the marketplace approach to health care policy started to gain popularity, important questions about the effects on the public welfare demanded (but did not receive) answers. Today these questions are as pertinent as when the author first posed them in 1980: How can we say that health care is a basic right and yet also support policies that put the consumer at risk? Since most hospitals still exist fundamentally to serve the public rather than to turn a profit, how can they reasonably be subjected to a policy strategy that favors survival only for the most prosperous? Without federal health planning, how can limited capital development funds be distributed rationally? What should replace cost as the method of paying hospitals? Will the public accept a cost-control strategy that puts physicians in control of the flow of dollars? How can graduate medical education be financed in the years just ahead? How can we adapt the services of the community hospital to the public's radically changing needs? How can medical and social services be effectively integrated, both inside and outside of hospitals? How can we ration health services equitably and humanely? What is the appropriate level of government for the financing of health services for the aged, the poor, and the disabled? No consensus on these issues exists among either the public or health care professionals, and government is unlikely to take the lead role in initiating a rational decision-making process. Until such consensus is reached, budget-cutting will be the primary activity of health care policymakers.