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In this volume, the nation's leading advisors on health policy and financing appraise America's ailing healthcare system and suggest reasonable approaches to its rehabilitation. Each chapter confronts a major challenge to the country's health security, from runaway costs and uneven quality of care to declining levels of insurance coverage, medical bankruptcy, and the growing enthusiasm for health plans that put patients in charge of risk and cost. Bringing the latest research to bear on these issues, contributors diagnose the problems of our present system and offer treatments grounded in exte

Reports from abroad on the American condition have a special place in the canon of social commentary. There is Lord Bryce's American Commonwealth (1888), Gunnar Myrdal's American Dilemma: The Negro Problem and Modern Democracy (1944), Werner Sombart's Why Is There No Socialism in the United States? (1906) and, of course—the standard setter—Alexis de Tocqueville's Democracy in America in 1835. What makes these works touchstones is not just the quality of the analysis or the fame of their authors but the privileged status they have come to enjoy as works of external reflection and criticism. For a people prone to ignore the rest of the world or see abroad only a mirror image of themselves, Americans have always had a surprisingly soft spot for the foreign observer willing to discourse on what makes their nation unique.

Frontmatter -- Contents -- Preface -- Introduction: The Puzzle -- Chapter 1. The Rise of Reform -- Chapter 2. A Prescription for Reform -- Chapter 3. The Liberal Synthesis -- Chapter 4. The Campaign -- Chapter 5. The Plan -- Conclusion -- Appendix A. Methodology -- Appendix B. Jackson Hole Participants, 1990-1992 -- Appendix C. California Insurance Commissioner's Health Care Advisory Committee -- Notes -- Index

How can the American social welfare system be repaired so that workers and families receive adequate protection and, if necessary, provision from the ravages of the market? This book addresses this fundamental problem and analyses how the 'privatization of risk' has increased hardships for American families and increased inequality. It also proposes a series of solutions that would distribute the burdens of risks more broadly and expand the social safety net.

America's leaders say the economy is strong and getting stronger. But ordinary Americans aren't buying it. They see what the rosy statistics hide: We are all struggling under the weight of terrifying economic instability. No matter how well educated and hard working we are, we know that the bottom can fall out at any moment. Meanwhile, the safety net that once protected us is fast unraveling. With retirement plans in growing jeopardy while health coverage erodes, more and more economic risk is shifting from government and business onto the fragile shoulders of the American family. In The Grea