Health reform: the new reality.

In 1965 the poor and elderly did not have access to health care. To alleviate this problem Medicare was implemented. Major changes in health care occurred as a result. Initially, payers paid whatever was billed, which led to perverse incentives toward overutilization and inefficiency. It has been estimated that by the year 2000 the total health care expenditure will reach $2 trillion. Currently, we are again faced with approximately 37 million people who are uninsured and who do not have access to health care. It is not just the poor and elderly who have no access, but rather a broad spectrum of the American people. The current system cannot be sustained. Much has been written and proposed to support health care reform. It is imperative that nursing leaders have a clear understanding of what is being proposed and how that will impact hospitals, physicians, and nursing.