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Health Services Research Program, School of Medicine and Biomedical Sciences, State University of New York, Buffalo 14214.
It is not surprising that our health care system seems stalled in a developmental time warp, insulated from pressures to change. Everybody knows what should be changed, but changed to what? There is no national health policy that provides the context to redesign the health care system or even plan its incremental improvement. The self-interest ethos of the 1980s allowed decades of health and social advances to be rescinded with hardly a whisper of outrage. The more sophisticated our medical technology became, the more indifferent was the response to the real health needs of our society. Neither a society nor a health care system can survive without virtue or a cause that supersedes individual interests. Our health care cannot progress without an articulated purpose, a common vision expressed as policy that eliminates ambiguity of purpose, ambivalence towards performance standards, conflicts of principles, and contradictions of goals. The challenge calls for great leadership--to define policies that reverse the decline in both the indices of health and the political will to address the public good. To attempt less would allow this country's health care system to go down any road the vagaries of our political process take it.
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