In an article in the December 5, 2001, New York Times, Milton Freudenheim reported that most ofAmerica's largest insurers of healthcare are moving toward insurance design that increases segmentation of the private insurance market, with the sickest having to bear more of the costs while the well will be able to get coverage more inexpensively. This gives further impetus to the movement of employers to defined contribution for health insurance and the growth of high-deductible plans, leaving workers to decide for themselves how much to add from their own sources to acquire coverage. While framed as "choice," this leads to higher costs for patients, especially for the chronically ill or genetically at risk.
All this leads Victor Fuchs (2002) to join others in predicting that there will be a reemergence of interest in social insurance and a national insurance program, essentially because of the inequity and unfairness of what the employment-based system will have become.
At this point, it is safe to assume that healthcare institutions in the United States are caught in a continuing confluence of marketplace forces churning against strong ethical and social currents. Until this ambiguous situation is resolved, it is hard to predict the future for these institutions, but it is clearly more and more difficult for institutions such as hospitals and healthcare systems to be moral leaders.
ROGER J. BULGER CHRISTINE K. CASSEL (1 995) REVISED BY AUTHORS
SEE ALSO: Healthcare Resources, Allocation Of; Healthcare Systems; Hospital, Modern History of the; Long-Term Care; Mergers and Acquisitions; Privacy in Healthcare
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