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January 4, 1995

The Health Care MessA Bit of History

Author Affiliations

From the Department of Social Medicine, Harvard Medical School, Boston, Mass.

JAMA. 1995;273(1):69-71. doi:10.1001/jama.1995.03520250085039

THERE is general agreement that both the financing and the organization of US health care services are a mess. The public image is that confusion, complexity, and contradictions arise because earlier health policies did not work to accomplish their goals. Yet, an examination of how what has been termed a "mess" developed, as well as the nature and dimensions of the mess, reminds us that the public image of health policy is at variance with the historical record. It is important to understand that health policies did work. Those who ignore or misinterpret history and are skeptical that policies can be effective are wrong.

BACKGROUND  In the period following World War II our health policies worked extraordinarily well. They resulted in a number of spectacular successes. For example, we faced a shortage of health care personnel, a deficiency of acute care general hospital beds, and a relatively low level of

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