Many Americans have access to some of the best health care in the world. Others are not as fortunate. Health care expenditures in the United States, already the highest in the world, continue to increase at a seemingly uncontrolled rate. From 1980 to 1989, US health care expenditures increased by 128%.1 Despite this tremendous investment in health care, our system is increasingly coming under attack. The quality of US health care, as judged by indexes such as infant mortality, does not compare well with other countries that spend much less on health care.
The May 15, 1991, issue of the Journal of the American Medical Association and the May editions of the American Medical Association's (AMA's) specialty journals focus on another critical defect in our health care system—more than 30 million Americans have no health insurance; additional millions are underinsured. Friedman1 estimates that the percentage of our citizens who