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Health Care

With an estimated 43 million Americans lacking health insurance and a medical care system that eats up ever-larger percentage of the gross domestic product, health care remains an intractable issue.

In his first term, President Bill Clinton had promised "universal access to quality, affordable health care, not as a privilege but as a right." His bold September 1993 plan for universal coverage blew up in his face, though, and since then, Clinton and lawmakers have had to settle for a strategy of tweaking the system at the margins.

There are still hard decisions to come on how to control costs in the Medicare and Medicaid programs. In recent years, annual cost increases in each program have averaged about 10 percent, although last year saw much smaller jumps. For Medicare, costs are expected to climb significantly as Baby Boomers retire and their physical condition declines. The Medicare system is projected to run out of money by 2002.

Many people within the health care system argue that the U.S. has the best system in the world, but there are few incentives to economize, and health care now accounts for 14 percent of the nation's gross domestic product.

The biggest problem may be the inequality of it all. Seniors get guaranteed coverage, while many younger workers labor in temporary or part-time jobs without benefits. So far, there appears to be no consensus on either how to control costs or extend health coverage to more people.