ABSTRACT
This chapter discusses some obvious anomalies and inequities in the present United States (US) health care system, and raises questions about values and goals, as evidenced in the US system as presently structured, and finishes with some nuts and bolts questions of strategy. An outside observer looking at US health insurance arrangements who is unaware of the quirks of history might assume that present American insurance patterns were a natural outgrowth of the equity assumptions of industrial capitalism, with benefits designed primarily to protect worker productivity—and little concern about anyone else. The realities of exclusion and deficiencies in the American health care system provoke relatively little passion or interest, whether one is talking about the distribution of health insurance, health status, or utilization. The goals and values of the American health care system are intrinsically different from those of the United Kingdom and thus questions of equity have to be conceived differently.
