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(Circulation. 2000;101:2015.)
© 2000 American Heart Association, Inc.

Current Perspective

The US Healthcare System 2010

Problems, Principles, and Potential Solutions

Arthur Garson, Jr, MD, MPH

From the American College of Cardiology, Bethesda, Md.

Correspondence to Dr Arthur Garson, Jr, American College of Cardiology, Heart House, 9111 Old Georgetown Rd, Bethesda, MD 20814-1699. E-mail tgarson@bcm.tmc.edu

Key Words: healthcare reform • healthcare system • health policy • future of healthcare • uninsured

	Introduction

 
Ten years ago, the US healthcare system was declared "broken," and it has not improved. Fixes promised by managed care have not materialized. Premiums are rising. Hassles for patients and physicians abound. Nearly 45 million Americans are uninsured.

Over the next decade, these problems will worsen and new challenges will arise. Although new technology will increase efficiency, the cost of new tests and treatments will outweigh the savings. As physicians get better at treating problems, they will lengthen patients’ lives and increase the number of people requiring care. As baby boomers age, these new patients will demand top-quality care "their way."

As costs rise, the status quo will not be acceptable to employers. Some will eliminate benefits for new hires. Others will get out of the insurance business entirely, contributing some funds to coverage costs but no longer providing coverage themselves. These changes will cause the number of uninsured citizens to grow. The result will be an increasingly disenfranchised middle class. They—and employers—will vote for radical change.

In my role as a citizen rather than as the president of the American College of Cardiology (ACC), I have developed a proposal to transform our healthcare system by the year 2010. This proposal outlines 6 problems, 6 principles for addressing them, and potential solutions.

	Problem 1: Uninsured

 
Principle 1: Universal Coverage
Any viable plan for the future must be based on universal coverage, and the "2010 plan" guarantees every American enrollment in a basic health plan of his or her choice (not necessarily a health maintenance organization). Like automobile . . . [Full Text of this Article]