Dr Dalen neatly and comprehensively summarizes changes in America's nonsystem of health care in the managed care era1; his observations should be required reading for all law makers and available as a handout in physicians' offices nationwide. He wisely points out that health care reform (providing health services as the greatest good for the greatest number) will not be easy. But why not make a start? Dr Dalen lists groups that currently are "guaranteed health care." And here, our federal and state entitlements head the list: federal employees, veterans, Native Americans, Medicaid and Medicare recipients, and military dependents and retirees. Forty percent of our nation's health care is government-financed and inherently wasteful because it is fragmented into bureaucracies with their multiple regulations, varying eligibility requirements, and duplication of services.
Gelpi AP. America's Health Care Follies. Arch Intern Med. 2001;161(16):2050. doi: