Målene med en reform bude være, at få styr på omkostninger, øge kvaliteten og give alle borgere adgang til sundhedsforsikring. Men Flier mener ikke, at de tre mål med reformen bliver indfriet. Flere borgere bliver tvunget til at tegne forsikring eller får statsstøttet forsikring, men vil øge udgifterne og reformen forbedrer ikke kvaliteten:
"In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value."Med det store underskud på statsbudgettet kan det undre, at præsident Barack Obama og hans administration ikke gør mere for at standse stigningen i omkostninger, som primært skyldes at patienter og læger med adgang til forsikring i dagens og morgendagens system i USA forbruger sundhedsydelser for andres folks penge. Det er noget kamikaze pilot over det, men det er måske også meningen ifølge Flier:
"So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit.Hvad mon næste skridt bliver? Rationering?
We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead".
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