Proposals for national health insurance in the USA: origins and evolution, and some perceptions for the future.

Reliance upon private and voluntary efforts in health insurance has proved to be inadequate as the promise of medical science has become socially more complex, expensive, and elusive. The real, even if discontinuous, movement toward public and compulsory approaches to national health insurance is accelerating. Any program with reasonable promise of success must achieve both cost controls and systems improvements. Of the proposals before Congress, only one offers assurance that the good in the present system of care will not continue to be an enemy of the better system for the future.