The Journal of the American Medical Association and its family of specialty journals are addressing the issue of access to medical care. Matthew Menken presents a thoughtful look at this problem in a special article in this issue.1 One of the major priorities in most industrialized nations is the provision of universal access to high-quality medical care at low cost. There have been varying degrees of success and many failures, and an ideal program has not been found. Certainly, the system in the United States has failed as there are millions of citizens who are underinsured or poorly insured. Basic desiderata just mentioned fall apart when other elements are deemed important, as instant and convenient access to care, free choice, unrationed care, finest technology, and adequate reimbursement for the providers (hospitals, physicians, nurses). There is then a trade-off, and, unfortunately in this country, it is universal access. Also, as
Joynt RJ. Freeze the Ocean. Arch Neurol. 1991;48(5):471. doi:10.1001/archneur.1991.00530170031015
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