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February 1990

Health Care in the United States: Our Dynamic Jigsaw Puzzle

Author Affiliations

Department of Internal Medicine University of North Carolina Medical Center Chapel Hill, NC 27514

Arch Intern Med. 1990;150(2):256-258. doi:10.1001/archinte.1990.00390140012003

In 1983 the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, formed under President Carter and continued under President Reagan, stated, "Society has a moral obligation to ensure that everyone has access to adequate [health] care without being subjected to excessive burdens."1 The commission's use of the idea of societal obligation implies a pluralistic approach that relies on joint efforts of the private and public sectors. A long-standing controversy is to what proportions do these two groups monetarily and administratively contribute. William L. Roper, MD, administrator of the Health Care Finance Administration (the agency that oversees Medicaid and Medicare) under President Reagan, has stated that indigent care "is strictly a state problem." He defends this by further stating that "the federal government is broke, far more so than the states in aggregate."2 This viewpoint is one that the Reagan administration held