American medicine is financed today by a patchwork of systems formed around a concept of competitive voluntary health insurance that evolved over the past 50 years.

This article reviews the theory of health insurance from a clinical perspective to examine whether changes in medical science and practice have made such an insurancesystem obsolete.

As it is currently applied, a system of competitive voluntary health insurance conflicts with the goals of modern medical practice due to advances in screening and in treatment and the need to deal more effectively with paying for care of unknown efficacy.