ABSTRACT
So why describe the current state of American health care as a leaky vessel that is being plugged one hole at a time? Understanding the question requires recognizing that the current "system" (or "nonsystem") of U.S. health care with its primary link to employee-based coverage, and secondary link to age-related entitlements or demonstrable indicators of poverty or disability, still leaves many gaps in basic access to health care services that need to be filled. Moreover, even among the insured, or among those receiving Medicare or some version of Medicaid, there are still gaps in coverage that leave recipients and policyholders vulnerable to significant costs and limitations in care. Comparing the current system to a colander also reflects the significant hemorrhages in efficiency, effectiveness, and costs associated with a system seeking to rationalize itself via the rubric of managed care. While the growth in the rate of health care inflation has been significantly reduced from an annual growth rate of 11.6% in 1985 to a comparably modest 5.5% in 1995, health care costs remain a significant portion of the nation's gross domestic product (GDP), consuming 13.5% of the GDP and earmarking approximately $328 billion in federal revenue in 1995, or approximately 33% of the nation's (1995) health care expenditures ($988.5 billion) (Minor, 1998, pp. 102-103).
