Glaser W A
New School for Social Research, Graduate School of Management and Urban Policy, New York, NY 10011.
Lancet. 1993 Mar 27;341(8848):805-12. doi: 10.1016/0140-6736(93)90572-x.
Social security and comprehensive health care financing were developed to protect all citizens and to redistribute money to cover costs. Their inspiration was social solidarity rather than pecuniary self-interest. The United States differed from other countries by continuing a private market in health, with many self-centred and competing providers and insurers; and its prevailing school of health economics deplored the national health insurance and national health services that were universal in other countries and recommended devices that would eliminate "market failure" in health. When health economics grew in Europe during the 1970s and 1980s, the reformers' first presumption was that the voluminous American market-oriented literature must offer answers; but much of it proved superfluous, since European health care systems still had much competition and consumer choice, and they worked better than the reality in the United States. The United States itself has paid a heavy price for turning over health financing policy to the devotees of microeconomics and free markets, and today its serious problems in health are unsolved. So powerful is the pro-competitive ideology that it has now been adopted by the Democratic Clinton Administration, contradicting the heritage of Roosevelt, Truman, and Johnson.
社会保障和全面的医疗保健融资体系旨在保护所有公民，并通过资金再分配来支付医疗费用。其灵感源自社会团结，而非金钱私利。美国与其他国家不同，它继续保留着医疗领域的私人市场，存在众多以自我为中心且相互竞争的医疗服务提供者和保险公司；而且美国主流的健康经济学派谴责其他国家普遍实行的国家医疗保险和国家医疗服务体系，并推荐一些旨在消除医疗领域“市场失灵”的手段。20世纪70年代和80年代，当健康经济学在欧洲发展起来时，改革者们的首要假设是，大量以美国市场为导向的文献必定能提供答案；但事实证明，其中很多内容都多余，因为欧洲的医疗保健系统仍存在大量竞争和消费者选择，而且其运行状况比美国的实际情况要好。美国自身也为将医疗融资政策交给微观经济学和自由市场的信徒们付出了沉重代价，如今其严重的医疗问题仍未得到解决。支持竞争的意识形态如此强大，以至于如今民主党人克林顿政府也予以采纳，这与罗斯福、杜鲁门和约翰逊的传统背道而驰。
