And whenever a national single-payer model has enjoyed its periodic moments of political possibility, the powerful American Medical Association has opposed it. The fear is that, if we try to cover everyone, certain health care services will be limited because of increasing costs. Yet, even now, with the system of HMOs that has failed to make much of a dent in U.S. costs, there is a limit-setting of sorts. Physicians are increasingly required to obtain approval for treatments. Tensions are rising over who decides what treatments are experimental and thus often not covered.
Actual time spent with doctors can be unduly short.
And the still more dangerous and troubling limit-setting takes place not within managed care companies but outside them. The uninsured who have grown by nearly 10 million over the last decade are in effect denied coverage for all treatments. The inadequacies of American health care if not necessarily worse than those of other systems are less openly agreed upon. While there are limits to what we can and do spend on health, experts note a particular American aversion to publicly discussing them. Such an approach provides an opportunity to make sure health services are distributed equitably.