摘要：The American Public Health Association (APHA) has long advocated the development of a system of universal health care for all US residents. APHA has adopted several policies on this topic that stress the financing of the system of universal health care under a single-payer mechanism. However, this approach has never been adopted by US policymakers. The need for universal health coverage in the United States is growing more acute, and failure to provide such coverage threatens the health status of the public. I propose an alternative approach to the single-payer system that is based on incremental extension of existing coverage mechanisms, accompanied by fundamental reform of the health care delivery system. This approach is in keeping with the traditional methods of policy development in the United States, and I urge APHA to assume leadership in advocating it. THE MEMBERS OF THE American Public Health Association (APHA) have had a long-standing interest in the establishment of a system of universal health care for all US residents, and they have expressed this interest through the passage of several policy resolutions on this topic. The most recent of these resolutions were passed in 1995 and 2000. 1, 2 These policies call for the development of a universal system of health care with a single-payer approach to financing. This position has been maintained over the years despite the fact that it has never become the basis for successful legislative action. Why has APHA failed to obtain adoption of its preferred position on universal health care? In my opinion, it is because some of our key leaders have taken the intractable position that they are the sole possessors of truth on this issue and that the American people and their political leaders should listen to them. The fact that this line of reasoning has led to persistent rebuffs from Congress should make us aware that it is time to rethink the entire issue and develop a point of view regarding universal health care that respects the input of the other stakeholders, especially the public who will be served by the health care delivery system. Let us begin this process by reviewing the current status of health insurance coverage in the United States.
