Reshaping US health care from competition and confiscation to cooperation and mobilization

摘要

In this issue of JAMA, 3 Viewpoints, by Powers et al, Fuchs, and Fisher and Corrigan, address problems, possibilities, and mechanisms for reshaping the US health care enterprise to better meet community needs at an affordable cost. In their Viewpoint, Powers et al grapple with a question as old as democracy: How can productive collective action, which is required for a state to succeed, emerge from the factional divisions for which protection is required for democratic principles to succeed? The founding fathers of the United States debated this vigorously. In the most famous Federalist Paper, Madison favored a large republic in the hands of a meritocracy to counterbalance the passions of a majority "faction" that might overwhelm legitimate minority interests. Others wanted to protect states' powers, arguing that smaller political units could be more responsive to local groups.