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July 15, 1992


JAMA. 1992;268(3):344-345. doi:10.1001/jama.1992.03490030056027

In the election year of 1992, health insurance has been a central issue in the campaigns of politicians of every stripe. As the old saying goes, "Politics makes strange bedfellows," and so it is with health insurance. The business community is concerned that the cost of medical care makes the price of doing business in the United States too high. Middle-income Americans are worried that they cannot afford adequate health insurance. The poor are convinced that their medical care is excessively and unjustly rationed because they cannot buy access to it and because public programs are insufficient for them to gain entry to mainstream medical care.

Recent health services research has investigated the economics of access to care and has demonstrated that the problem is real and serious. Physician visits for low-income Americans decreased 8% during the middle 1980s, while visits for others, even controlling for the lower use expected