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Although the traditional means for affording access to goods and services in a capitalistic economy is the free market system, Americans have been unwilling in the past - for the most part - to either condone or accept financial ability as the central means for distributing health care. Responding to this attitude or consensus, the United States Congress established both Medicare and Medicaid programs to deal with the commitment to provide health care services regardless of ability to pay. Recent surveys show, however, that while the American public is concerned about the idea or principle of providing not only health care for all who are in need, but catastrophic health care coverage for cancer and cardio-pulmonary problems and long-term care as well, "there is actually a significant limitation on their willingness to pay additional costs" outside of those provided for medical reimbursement coverage in their health insurance policies.

Even though the federal government does not control directly total health care delivery spending or, for that matter, hospital budgets it can and does exercise considerable influence through funding of a multitude of health care programs. In this essay, the extent to which cost containment adds to or detracts from the goal of meeting a uniform standard of quality health care delivery will be analyzed and a construct for principled decision making developed.



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