THE ROAD TO REFORM

Clear analysis of how our health care system came to be the way it is and what challenges lie ahead. Director since 1950 of Columbia University's Eisenhower Center for the Conservation of Human Resources, Ginzberg (Beyond Human Scale, 1985, etc.) describes the factors—unprecedented federal support for biomedical research, a greatly increased supply of physicians, hospital growth and modernization, and massive restructuring of health care financing—that have reshaped our health care system since WW II. He asserts that much is right with the present system: it offers clinical excellence, a high level of quality control, and, for most Americans, freedom of choice of physicians. Its flaws, however, are serious—the principal ones being lack of universal access to appropriate care and skyrocketing costs. These, plus numerous others—such as an imbalance between specialists and general practitioners, overuse of technology, and burdensome regulations—come under the author's scrutiny. Having concluded that the present system cannot long endure, he considers what must be done to fix it. The first priority is to ensure its future financial stability. Once that is accomplished, Ginzberg says, we can begin to strengthen the health-care delivery system- -i.e., provide universal access, reform medical education, consider alternative modes of physician practice, restructure hospital services, and deal with quality assurance problems. Ginzberg gives President Clinton high marks for tackling the two most pressing issues of cost control and universal access, but if there is one message he delivers, it is that the health-care system has many facets and that no single program can reform its multiplicity of problems. Valuable as an overview—despite a tendency to be repetitious and to oversimplify complex issues.