Who's in charge here?—or Alice searches for a king in Mediland

Abstract

There is no king in Mediland. Despite Alice's yearning—and she speaks for millions who seek simple solutions to complex problems—there probably never will be, as long as we remain a democracy. What is needed is a shared, multi-group, responsibility within a framework of clearly, but democratically, defined public accountability. Five groups share major responsibility, for both our current problems and their solution: consumers, doctors, hospitals, private health-insurance carriers, and the government. Within this shared responsibility, the pre-eminent role will probably go to the group demonstrating greatest capacity for leadership, which, paradoxically, may mean greatest capacity for self-discipline. The extent to which this self-discipline and leadership are realized may determine whether we achieve a creative new synthesis for medical education, health-care delivery and financing, or whether we doom ourselves to a mutually destructive stalemate.

Key Words:

• Government role in health care reform
• health care reform
• US
• National Health Insurance (NHZ)