The health care system in the United States today is in a period of rapid changes on many different fronts. One example is the distribution of medical services. By the mid-1980s, the United States, in a reversal of a long-standing pattern, no longer faced a shortage of physicians. There was, in fact, a developing surplus of medical doctors. But physicians often prefer to practice in urban areas or comfortable suburbs. As a result, many inner city areas and rural communities still lack sufficient physicians and adequate medical facilities.
As the number of medical specialties has grown in recent years, patients sometimes have found it frustrating to deal with a number of different physicians for differing ailments, rather than with the traditional family physician. Medical schools have responded by creating a new specialty - family medicine. Such family physicians can diagnose and treat many kinds of illnesses, though they also send patient to specialists when necessary. Not every medical problem requires a highly trained specialist, or even a physician. In some communities, physicians' assistants, working with medical doctors, perform some routine medical procedures. Nurse midwives manage normal pregnancies and deliveries, calling upon obstetricians only if problems develop.
Another change in American medical practice is that profit-making corporations are playing an increasingly large role in providing medical care, and chains of private, "for-profit" hospitals are growing. Private companies also compete for contracts to run public hospitals for a fee, promising more efficient and cost-conscious management.
Can profit-making corporations deliver more economical and higher quality medicine? Or do they simply draw patients with sufficient funds or health insurance away from non-profit and public hospitals, leaving those institutions to cope with the poorest and sickest patients?
Liberal social critics deplore the lack of government planning and central oversight inherent in a free market approach to health care. Conservative critics, on the other hand, feel that government-funded health insurance and medical programs are inefficient and more expensive than private medical care in the long ran. Critics on both sides often agree, however, the medical profession has been given too much freedom in determining the cost of medical care.
While some groups might benefit from funds spent to improve medical care further, many people feel that differences in the way people live account for much of the health gap between rich and middle-class and the poor. Is it possible to spend too much money saving a single life? Would spending less money on advanced medical treatments increase the amounts available for better nutrition, pollution controls, safety devices, campaigns to increase exercise and cut back smoking, and other preventive measures. Should people be held responsible for habits and behaviors which make them sick?
Physicians, politicians, medical experts and ordinary citizens were debating these questions in the early 1990s. The answers are by no means clear-cut, but involve a number of trade-offs and compromises between equally desirable goals. In a nation in which more than 11 percent of the Gross National product (the value of all goods and services) is spent on medical services of all kinds, Americans are in agreement on one central point: Quality, affordable health care must be available to everyone.