Churchill’s Dictum and
the Next New Thing in
American Health Care
"In the end, Americans will always do the right thing -- after
exploring all other alternatives." Winston Churchill
By Uwe E. Reinhardt
Uwe E. Reinhardt is the James Madison Professor of
Political Economy and Professor of Economics and
Public Affairs in the Woodrow Wilson School of Princeton
University. He has been a member of the Institute of
Medicine of the National Academy of Sciences since
1978 and is a past president of the Association of Health
Services Research. From 1986 to 1995, he served as a
commissioner on the Physician Payment Review
Committee, established in 1986 by Congress to advise it
on issues related to the payment of physicians. He is a
senior associate of the Judge Institute for Management
of Cambridge University, UK, and a trustee of Duke
University and the Duke University Health System.
Reinhardt is or was a member of numerous editorial
boards, among them the Journal of Health Economics,
the Milbank Memorial Quarterly, Health Affairs, the
New England Journal of Medicine, and the Journal of
the American Medical Association. He holds a Ph.D.
from Yale University.
Although modern health care contributes very directly
and noticeably to the welfare of human beings, the health
care sector the world over is a source of never-ending rancor
and suspicion. Therefore, it is the target of never-ending
reform efforts that always are declared, ex post, to
have failed. It is so because health care is a product
whose intrinsic quality is poorly understood by providers
and consumers alike. Moreover, since the bulk of health care is now collectively financed by third-party payers, it
is only natural that payers and providers view each other
with permanent suspicion. Thus, it is safe to predict that
attempts at “health reform” will be a chronic activity
within the body politic. The paper describes the chronology
of health care in the United States and the fiscal burden
it now imposes on the federal government and private
providers. It also discusses currently popular proposals and
predicts that there are enough “new things” to explore
that Churchill’s dictum will hold indefinitely.
