SHARED SACRIFICE NEEDED FOR REFORM

The push for health system reform is sorely lacking the leadership to achieve the "shared sacrifice" necessary for a lasting solution, says George Lundberg, editor of the Journal of the American Medical Association. And he questions whether the US electorate, its official representatives and the medical profession"have matured to the point of being able to support the ethical principal of the greatest good for the greatest number?"

In a JAMA editorial, Dr Lundberg used expert assessments to grade the health reform proposals in Congress through an 11-item evaluation with a maximum score of 99 points. The current health care system scored 55. The leading reform proposal, with a 72 score, was introduced by Representative Fortney Stark; President Clinton's Health Security Act rated second, with a score of 70, and placed last was the proposal for Senator Phil Gramm, with a score of 38. The single-payer Medermott/Wellstone plan scored third highest (66) on the JAMA grid.

A key element for any reform package, he said, will be the assurance of universal access to basic health care by universal coverage, adding that reform should build on employment-based health insurance. He also said he supports "sin taxes" to raise additional money for the health coverage.