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March 20, 1987

Health Care in the Year 2000

Author Affiliations

New York City Health and Hospitals Corp

New York City Health and Hospitals Corp

JAMA. 1987;257(11):1472. doi:10.1001/jama.1987.03390110048013

To the Editor.—  Dr Goldsmith1 may be correct in his speculations concerning the provision of health care in the future; indeed, I often found myself nodding in agreement.Unlike Dr Goldsmith, however, I speculate that a variation of national health insurance will be implemented in the 1990s. He alludes to "the creation by state and local initiative... of local systems of health services." These local health care authorities will be similar to those that currently exist as the foundation of national health insurance in the United Kingdom.My scenario is based on the fact that health care costs over the past five years have been artificially low, in part because of the competitive marketing of national and regional managed-care programs; very shortly we will see a crisis in health insurance, similar to the recent liability insurance crisis.Well before 2000, the entire health care industry will have been perceived