Health care reform and global budgeting.

Americans seem to have reached a consensus about the urgent need to devise a cost containment strategy that leaves intact a pluralistic health care system. One option is global budgeting--the imposition of a national health care budget with all-payer price controls. This article reviews the factual and legal bases for global budgeting and examines proposed mechanisms to cap expenditures or fix prices for all medical goods and services. Also discussed are the implications of financial restraints on a free market economy, the experiences of other countries attempting to control health care costs while providing universal coverage, the complications of global budgeting, and ways to safeguard medical excellence and innovation if global budgeting is adopted.