Ani B. Satz


Nobody questions that the United States is in a health care crisis. Annual health care spending is over $1.9 trillion, 16% of the nation's GDP. Public spending is about 60% of that total, only 10% below that of public funding in countries with universal health care, yet there is no basic universal health care coverage and over 46 million people are uninsured. The daily news and print media are rife with distressing stories of underinsured individuals who are forced to declare personal bankruptcy, as insurers reimburse for fewer services and elevate co-insurance. In fact, 76% of individuals filing for personal bankruptcy due to medical expenses have insurance but are underinsured.

Not surprisingly, proposed health care reforms focus on the supply of health care goods to patients. The problem, as reformers see it, is a simple and obvious one: More people need access to basic health care services. As straightforward as this reasoning may seem, it is based on a misperception of critical points within the problem.