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The prognosis for U.S. health care: the health care system in the United States can provide technologically advanced treatments, but it still struggles to cover the basics. An expert outlines how to ensure more citizens access to high-quality health care.

Article Excerpt
Health care in the United States is a major industry that touches everyone. But it is also a troubled one, with costs accounting for 16 percent of the nation's gross domestic product, according to the Centers for Medicare and Medicaid Services.

Costs of health care doubled between 1993 and 2004, recently increasing faster than either inflation or incomes. At the same time, according to the Agency for Healthcare Research and Quality, measurements of the quality of care show little improvement from year to year. In addition, other studies detail sometimes alarming disparities in care, a growing population of uninsured citizens, and a shrinking percentage of employers providing health coverage to U.S. workers.

To discuss the present and future state of health care, economist Paul Ginsburg talked with TRIAL Associate Editor Valerie Jablow. Ginsburg is the president of the nonpartisan Center for Studying Health System Change, in Washington, D.C. By conducting studies of the health care system, Ginsburg and the center's researchers identify trends to help policymakers understand health system change and to support them in their decision-making.

TRIAL: What do you consider the most important trends in U.S. health care over the last 5 or 10 years, and how have they affected access to, and quality of health care?

Ginsburg: One of the most important trends has been the retreat from restrictive models of managed care. This occurred at a time of a booming economy, tight labor markets, and high profitability for many employers. Employers told health plans that they wanted less restrictive managed care products, which meant employees enjoyed broader provider networks, reduced authorization requirements, and greater freedom to consult specialists without seeing a primary care physician first.

But this led to...

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