Health Care Tickets for the Uninsured: First Class, Coach, or Standby?
Welch, H. Gilbert
New England Journal of Medicine. 1989 Nov 2; 321(18): 1261-1264.
Proposals for providing health care for uninsured Americans have focused on questions of cost and funding, with less attention paid to what services should be paid for. Welch, a physician, focuses on what coverage can be provided for the uninsured and attempts to define a middle ground between the impossibility of covering all services, and the unacceptability of covering none. He argues for expanding Medicaid coverage while introducing new efficiencies in the program as a step toward universal insurance. Using Medicaid programs in Oregon and in California's Alameda County as examples, Welch advocates the creation of a review process to establish coverage priorities in health services as a step toward defining adequate health care. Physician cooperation will be essential in formulating and implementing a national health policy that acknowledges the need for expanded access, budgetary restrictions, value judgments, and sharing resources with other worthy social programs. (KIE abstract)
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