The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research stated in 1983 that "Society has a moral obligation to ensure that everyone has access to adequate care without being subjected to excessive burdens."1 By this measure, the health system of the United States is failing, since millions of citizens are unable to obtain necessary care each year. This is a paradox, given the large annual medical care expenditures in the United States. In 1991, such expenditures will exceed $600 billion, or 11.5% of the gross national product, an average of $2500 per capita. Comparative health care figures reveal that the United States spends per capita 38% more money than Canada, 88% more than West Germany, and 124% more than Japan. Moreover, expenditures in the United States are rising rapidly. Between 1980 and 1987, health expenditures in the United States increased from $248
Menken M. Caring for the Underserved: Health Insurance Coverage Is Not Enough. Arch Neurol. 1991;48(5):472–475. doi:10.1001/archneur.1991.00530170032016
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