Americans Report On Their Access To Health Care

Prologue: Most Americans believe that health care should be available to all those who are sick or injured, regardless of economic or other circumstances. At the same time, most Americans consider the cost of medical care as the most troubling dimension of the provision of this service, and believe that cost constraints should be applied. Where to make such reductions without erasing the gains achieved in access to care over the last several decades, or hurting the least fortunate among us, is the issue. In this lead essay, Howard Freeman and his colleagues report signs of deterioration in access to medical care for the nations poor, minorities, and uninsured. Their study is the third study on access underwritten by The Robert Wood Johnson Foundation. The two previous access studies, ironically, provoked substantially different reactions, stemming more from a change in the political climate than from the findings themselves. At the time of the first survey, 1976, national health insurance (NHI) legislation was a live issue. Its advocates were critical of the survey results because they showed many more people with access to care than NHI rhetoric suggested. In the more constrained climate of 1982, the second survey provoked criticism from conservative quarters because it highlighted the relatively small number of people who lacked access to care. The lead author of this most recent survey is a professor of sociology at the University of California, Los Angeles (UCLA). Robert Blendon, who holds a doctorate in health policy and management from The Johns Hopkins University, is a senior vice-president of the Johnson Foundation. Linda Aiken, a nurse and sociologist, is a vice-president of the Johnson Foundation. Seymour Sudman is a professor of sociology at the University of Illinois. Connie Mullinix, who is working toward a doctorate in health services research at the University of Pennsylvania, is a research associate at the Johnson Foundation. Christopher Corey is a doctoral student in sociology at UCLA.