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May 1991

Redoing the Health Care Quilt: Patches or Whole Cloth?

Author Affiliations

From the Department of Pediatrics, School of Medicine, University of Miami (Fla).

Am J Dis Child. 1991;145(5):499-504. doi:10.1001/archpedi.1991.02160050025004

The current health care system of the United States, like a quilt that is tattered and full of holes, badly needs attention. The question is whether we should repair it with patches or replace it with a new quilt of whole cloth. That the system needs fixing is evident; the deficiencies have been described by abundant commentaries. The major deficiencies include those cited below.

The Uninsured.  —An estimated 37 million people in the United States do not have health insurance. Of these, about 12 million are children; another major segment comprises pregnant women. These numbers are estimated to have increased approximately 30% in the last decade. This reflects lack of employee coverage, particularly in small businesses, and a high rate of job turnover. It also reflects an inadequate Medicaid program that varies by state but that generally leaves a significant fraction of indigent families uncovered. The problem of uninsured children

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