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Examines reasons for the growth of health maintenance organizations and managed care, the problems engendered, and why they continue despite dissatisfaction among key participants.

Advocates universal & comprehensive health insurance (1) to cover the 16% of Americans who now have no public or private coverage; (2) to help hospitals pressured to end the cross-subsidies that previously enabled them to care for the uninsured; (3) to protect the jobs &, thus, the communities of health care workers; & (4) to improve the care received by the currently underinsured. It is allowed, however, that the US nonparliamentary political system all but precludes the enactment of the sort of ambitious, cohesive plan needed to repair the health care system. Thus, even though an incremental approach tends to politically weaken those it does not directly help, several smaller steps for improving the organization & financing of care are suggested: (A) slowing the shift of not-for-profit providers to the for-profit sector, possibly through the power of the states' attorneys general; (B) regulating & demanding greater accountability from health maintenance organizations; & (C) strengthening & improving Medicare. E. Blackwell

The design of a health care reform program requires contributions from many disciplines. While we know that all disciplines are equal, we are also aware that some are more equal than others. I believe the record would show that, at this time and in this nation, economics is one of the fields of study that is "more equal" than others. Why are economists so important? What impact does the presence of these economists have on the development of health reform legislation? What price—if any—do all of us pay for the under-representation of various other disciplines? Some of the answers to these and other questions can be found in the accompanying essays by persons whose knowledge and experience lies in the field of political science. I propose to try to address these matters from the vantage of the discipline in which I was educated—political economy, as it was known at Johns Hopkins when I studied there.It is not difficult to list some of the various factors that have propelled economists to the center of America's health care debate. Certainly it is the case that many of the issues raised by the health crisis and by proposals for health reform impinge on the economist's domain. Even without taking account of the imperialistic tendency of economists to view all of human behavior as that of rational economic actors and thus to lay claim to the study of virtually all human interactions, numerous matters do legitimately fall within the scope of economics and are of long-standing concern to economists.

A summary of data on twin problems in the health field: (1) the increasing number of Americans without health insurance; & (2) the increasing costs of health care. It is argued that these problems can be addressed by a national health insurance program that makes comprehensive benefits universally available & that operates within prescribed budgets. The characteristics of such a program are discussed. AA