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November 18, 1992

Memorandum to the President-ElectParameters for Health System Reform

JAMA. 1992;268(19):2699-2700. doi:10.1001/jama.1992.03490190099039

During the campaign, both you and your opponents made strong commitments to reform the US health care system. You were not alone in this concern; by mid-1992, there were over 50 separate reform proposals on the table, containing a multiplicity of provisions.1 However, there is more agreement about constructive actions to take than this large number of proposals would imply. The purpose here is not to add yet another proposal to the long list, but rather to identify some broad areas of consensus.* Within these areas, you can achieve political support for system reform that would make a difference.

The Problem  Health care costs are growing at an unsustainably high rate. Per capita spending in the United States far exceeds that in any other country, both in absolute terms and as a percentage of income. Nonetheless, some 35 million Americans have no health insurance. Others have insurance that is