The Failure of Organized Health System Reform—Now What?

Abstract

As regularJAMAreaders know, we editors have been working seriously on American health system reform since at least 1987. Our early efforts emphasized volunteerism and the absolute responsibility of physicians as learned professionals to deliberately give away free care to those in need, following a 1847 American Medical Association (AMA) tenet: "To individuals in indigent circumstances, professional services should be cheerfully and freely accorded."¹ In 1990, the AMA approved as policy "Health Access America," a 16-point, middle-of-the-road, honest effort at fixing the system's many problems.²In 1991,JAMAand the nine AMA Archives journals launched the "Caring for the Uninsured and Underinsured" campaign, spearheading a major professional effort at much-needed reform. Since then, we have published literally hundreds of articles, featuring research, analysis, history, proposals, and passionate rhetoric calling for reform and pointing the way.³ With the 1992 election results and the public mood, national reform