The best medical care in the world does not automatically make the best health- care system. A system is the sum of its parts, and while the United States is professionally and technically brilliant, it leaves 44 million uninsured by its "system."
In no important health indicator do Americans lead the developed world. Like the man who knew seven languages and had nothing to say in any of them, we overrate our technical proficiency. To cover all its citizens with modern medicine, a nation must subsidize those who can't afford coverage, avoid "free riders" by compelling all to pay something into the system, and set limits on what is covered.
Limits are painful but inevitable. Health care is a fiscal black hole that can crowd out all other social spending. Every government program in health care has ended up 10 to 15 times more expensive than anticipated.
As Oregon Gov. John Kitzhaber argues, to have an ethical medical-care system we must expand our moral radius and admit it's better to ration what we cover than whom we cover.
The price of compassion is honestly facing financial limits. Taxpayers now fund 50 percent of health care and can't blindly pay for all treatment every doctor thinks beneficial for every patient. It's not generally medical providers, but health insurers, who deny care. Doctors and hospitals focus on the individual and pride themselves that cost is not a consideration. Public policy must look at all social needs, and cost must not only be a consideration but a major consideration. Being in government is like sleeping with a blanket that's too short. You try to find resources for everything but something's always uncovered.
Thus the biggest challenge in health care reform is to get the American public to recognize that while it can have a lot, it can't have everything. No medical system can resolve every doubt and succor every anxiety. A modern medical care system can pay for the statically probable but never all the clinically possible.
America must recognize, in the words of health economist Victor Fuchs, that: "A nation can provide all of its people with some of the care that might do them some good; it can provide some of its people with all of the care that can do them some good, but it cannot provide all of its people with all of the care that might do them some good."
No medical-care system can optimize the health of both the individual and the nation, and neither can it optimize both the quality and quantity of life. Limits must be admitted, and choices faced honestly. All nations and all medical-care systems "ration" medicine. The sooner we recognize this, the faster we'll cure our brilliant but flawed health-care system.
*Richard D. Lamm, former governor of Colorado, directs the University of Denver's Center for Public Policy and Contemporary Issues.
(c) Copyright 1999. The Christian Science Publishing Society