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January 18, 1995

The First Step

JAMA. 1995;273(3):251-253. doi:10.1001/jama.1995.03520270087045

When we started the health system reform debate, we aspired to a health care system characterized by universality, affordability, security, and choice. Nothing has happened to justify abandoning these health system reform goals.

The number of uninsured Americans is increasing, and today almost 40 million of us are without coverage.1 More employers are dropping insurance, and when people change jobs, their new employers are less likely to provide comparable health benefits.2,3 In just 5 years, the average health insurance premium for a family will be $9500 per year, not including co-payments and deductibles, assuring that health insurance will be unaffordable to Americans who do not receive coverage through their employment (unpublished data, Congressional Budget Office, 1994).

Those Americans who do have insurance are increasingly unable to choose their own physicians and hospitals. Involuntarily forced into managed care plans selected by their employers, more Americans lose their physician every

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