Dissatisfaction with the U.S. health care system is widespread, but no consensus has emerged as to how to reform it. The principal methods of finance -- employer-based insurance, means-tested insurance, and Medicare -- are deeply and irreparably flawed. Policymakers confront two fundamental questions: Should reform be incremental or comprehensive? And should priority be given to reforming the financing system or to improving organization and delivery? We consider here several proposals for incremental reform and three for comprehensive reform: individual mandates with subsidies, single payer, and universal vouchers. Over the long term, reform is likely to come in response to a major war, depression, or large-scale civil unrest.

On May 4 and 5, 2000, health care leaders, professionals, and academics convened at the Bechtel Conference Center at Stanford University for the Health Care Conference 2000. Sponsored by the Comparative Health Care Policy Research Project at the Asia/Pacific Research Center (Shorenstein APARC), in cooperation with the Center for Health Policy (CHP), the conference was held for the purpose of discussing health care policies and issues facing nations today. With the pressures of rising costs, aging populations in industrialized countries, and rapid technological advancements, the need for an accessible, affordable, and effective health care system is urgent and greater than ever. The first conference of its kind at Shorenstein APARC, the Health Care Conference 2000 established a forum for candid discussion about the past, present, and future of health care. Over sixty participants attended the conference. The panel consisted of speakers from governmental institutions, for-profit and nonprofit organizations, universities, and research institutes. The first day of the conference featured a discussion on the evolution of the health care market in the United States, while the second day focused on the effects of market forces overseas, specifically in England, Japan, the Netherlands, New Zealand, Scotland, and Singapore. The 1990s marked an era of major health care reform. For many nations with socialized health care systems, it was a decade to explore alternative systems and to move toward privatization. The implications of such changes were discussed in detail at the conference. The Health Care Conference 2000 was a successful and informative meeting, which opened the doors for future discussions on issues concerning health care around the world. These proceedings present, in edited form, the remarks of all primary conference speakers. Please contact Shorenstein APARC if you have any questions about the conference, or about the Center's work in general.