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The 28th Amendment
- Frank Davidoff, MD; and
- Robert D. Reinecke, MD
- American College of Physicians-American Society of Internal Medicine; Philadelphia, PA 19106 (Davidoff) Jefferson Medical College; Philadelphia, PA 19107 (Reinecke)
- United States
- Constitution and bylaws
- Health services accessibility
- Delivery of health care
- Universal coverage
The litany of U.S. health care woes is depressingly familiar: the only industrialized nation without universal access to health care; 44 million persons uninsured, most of them employed; one in every four Americans either uninsured or underinsured on any given day; an infant mortality rate higher than that of most other industrialized countries; decent care at the end of life increasingly unaffordable; a life expectancy ranking between 16th and 21st in the world (black men in Harlem are less likely to reach the age of 65 or even the age of 40 than are men in Bangladesh)—the list goes on. Tragedy is compounded by irony here, given that we already spend $1 trillion annually on health care and that the quality of care, for those who can get it, is unparalleled.
Looking ahead, there is the special irony that we may never realize the enormous potential benefits of the Human Genome Project because persons found to be at increased genetic risk are likely to be excluded from health care coverage. What's worse, the system continues to unravel despite an ever-changing patchwork of laws, organizations, and financing plans designed to increase access for at least some groups (1-3) and despite the best economic times the country has known for decades. As noted by Donald Light elsewhere in this issue (4), employer-based insurance is shrinking, coverage for poor children is lagging, and the managed care “revolution” is widely seen as being at least as pernicious as beneficial. And what will happen when recession hits, as it inevitably will? It hardly bears thinking about.
In short, the health care system in the United States is an embarrassing, world-class mess. Of course, our inability to make a better, if not a perfect, system does not result from lack of trying (5). Unfortunately, …
