EQUITY, ACCESSIBILITY, AND ETHICAL ISSUES - IS THE UNITED-STATES HEALTH-CARE REFORM DEBATE ASKING THE RIGHT QUESTIONS

This article argues that the focus and scope of the current U.S. healt h care reform debate are too narrowly defined and the answers being of fered are therefore inadequate. The question implicitly or explicitly being addressed is how to assure more universal access to medical care . An alternative focus for an informed health policy debate is how bes t to assure more universal access to health. Fundamental investments i n enhancing the economic and social well-being of American families an d neighborhoods may offer the greatest long-term possibilities for imp roving their physical, psychological, and social health and well-being . Providing more universal access to medical care may have some, but a more limited, effect in terms of improving individuals' and the natio n's health. Competing universal health insurance proposals should be e valuated in terms of these effectiveness, as well as equity and effici ency, criteria Ultimately, this article argues that a coherent and eff ective policy framework for improving the nation's health requires a b roader vision and set of objectives than simply reforming methods of p aying for medical care.