No matter who is in charge of health policy, no matter what his or her ideological bent, no matter whether the economy is in boom or bust, three concerns stubbornly dominate the discussion: the cost of care, access to care, and the quality of care. The main variation among them is that normally each in turn receives the most attention from policy makers, payers, and the public, over time.

Cost Control↗

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What happens because of how we choose: the case of children.

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Child↗

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Rationing healthcare: crisis and courage.

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Decision Making↗

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Taxation as metaphor. The hospital and public responsibility.

In the debate over the tax status of voluntary hospitals, most hospital executives and trustees do not seem to comprehend--or want to comprehend--the underlying issues. First, the terror of being associated with a tax hike has led many politicians to seek other "revenue enhancements" that are more ingenious than they are honest. On the other hand, many of these governments have legitimate financial problems and are seeking new sources of revenue. A second, related issue is uncertainty over what should be done about the uninsured and Medicaid populations. In the absence of an acceptable solution, we will continue to provide direct public support to public hospitals and indirect public support to private providers--including charitable tax exemptions. The third underlying issue is hospitals' curiously narrow view of their private-sector status. Most of the functions hospitals provide are not only publicly funded; they are, in fact, public functions. Finally, hospitals believe they are inherently moral organizations because they provide an inherently moral service. But hospitals grew to their present role in society almost by accident; their services are neither unique nor ethically superior. It is in how hospitals provide care that their morality can be measured, not in the fact that they provide some kind of care to somebody. An honest appraisal of these issues will help each hospital answer the basic question: As an ethical and moral matter, should this organization be paying taxes? But is this fight really about taxes? I believe society and government are using taxation as a metaphor for trust in hospitals.

Community-Institutional Relations↗

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America's growing diversity: melting pot or rainbow?

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Birth Rate↗

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The ethics of empires.

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Ethics Committees↗

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Paradise lost: a 21st century fable.

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Economics, Hospital↗

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As long as it comes out all right.

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Confidentiality↗

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A matter of principle.

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Confidentiality↗

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The elusive cure: health care reform.

Everyone seems to believe Americans are entitled to the best health care, regardless of cost. But how to curb soaring health expenses and provide care to the 37 million uninsured in our country is a perplexing problem, one that policy makers and providers are trying to solve with a wide variety of health reform proposals.

Attitude to Health↗

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