This article argues that the focus and scope of the current U.S. health care reform debate are too narrowly defined and the answers being offered are therefore inadequate. The question implicitly or explicitly being addressed is how to assure more universal access to medical care. An alternative focus for an informed health policy debate is how best to assure more universal access to health. Fundamental investments in enhancing the economic and social well-being of American families and neighborhoods may offer the greatest long-term possibilities for improving their physical, psychological, and social health and well-being. Providing more universal access to medical care may have some, but a more limited, effect in terms of improving individuals' and the nation's health. Competing universal health insurance proposals should be evaluated in terms of these effectiveness, as well as equity and efficiency, criteria. Ultimately, this article argues that a coherent and effective policy framework for improving the nation's health requires a broader vision and set of objectives than simply reforming methods of paying for medical care.
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