Managed care has derailed a national focus on building a strong primary care infrastructure by pretending to be organized around primary care. Unfortunately, a poorly informed public focuses on the ills of managed care without understanding how managed care got here in the first place. People want direct access to specialists, in the mistaken belief that this will improve their health, without any recognition that they risk harm to health from over-use of potentially dangerous interventions. The evidence is clear that the best way to achieve better health is to greatly enhance the contributions of primary care, which focuses on meeting and solving people's health needs, including appropriate referrals when they are indicated. A more informed public and better public policy will have to be marshaled to address the many possible approaches to reducing the systematic disparities in health across population subgroups and the relatively dismal health status of this nation.
Income redistribution is important, but it is unlikely to happen any time soon.
In the meantime, other strategies, including improving the equity-enhancing aspects of health systems, are likely to be more practical and feasible. Copyright Boston Review , 1993-2000. All rights reserved. Please do not reproduce without permission.