American health care system management objectives: the aura of inevitability becomes incarnate

Reforming the nation's health care system promises to be a long, challenging, divisive battle. While most Americans see the need for fundamental changes, there is no consensus on how to proceed. The two basic issues any health care proposal must address are improving access for all and controlling escalating costs. Other reform elements include reducing administrative hassles and costs, encouraging primary care, ensuring quality of care, promoting disease prevention and maintaining necessary physician and patient autonomy. One of the most difficult tasks will be identifying futile services and reducing the money spent on unnecessary and marginal medical care. Cutting back on such services as unnecessary diagnostic tests and procedures will also require that professional liability be limited.